Clinical Significance of Endothelin-1 And C Reaction Protein in Restenosis After the Intervention of Lower Extremity Arteriosclerosis Obliterans

Relationship of Serum Fibroblast Growth Factor 23, Hypoxia-Inducible Factor-1α, and Klotho with In-Stent Restenosis in Elderly Patients with Coronary Artery Disease after the Treatment of Percutaneous Coronary Intervention

In-stent restenosis (ISR) commonly occurs in elderly patients with coronary artery disease (CAD) after percutaneous coronary intervention. Atherosclerosis in elderly patients may be the leading cause of ISR. Therefore, we aim to explore the relationship between vascular calcification-associated factors and ISR occurrence. Elderly patients were enrolled according to standard inclusion and exclusion criteria. The serum fibroblast growth factor 23 (FGF23), hypoxia-inducible factor-1α (HIF-1α), and Klotho levels were determined using an enzyme-linked immunosorbent assay. The degree of coronary artery stenosis of the patients with CAD before operation was assessed using the Gensini score. The correlation was analyzed using Pearson analysis. The prediction value was evaluated using receiver operating characteristic (ROC) curve analysis. The patients with CAD were classified into the ISR group with 97 cases and the non-ISR (NISR) group with 349 cases. The Gensini score, serum FGF23, and HIF-1α levels increased while Klotho levels decreased in patients with CAD of the ISR group compared with those of the NISR group. Pearson analysis showed that FGF23 and HIF-1α positively correlated while Klotho negatively correlated to the Gensini score. ROC analysis showed all three factors could effectively predict the occurrence of ISR. Furthermore, the joint had a more effective prediction value for ISR occurrence. The dynamic analysis presented that the serum FGF23 and HIF-1α levels dramatically increased while Klotho levels decreased in patients with CAD after 1-year follow-up. Serum FGF23 and HIF-1α positively correlated while serum Klotho negatively correlated to ISR. Conclusively, these three factors effectively predicted the occurrence of ISR.

Exploring the Novel Potential of Serum SIRT1 and TIMP3 as Biomarkers for In-Stent Restenosis Following Percutaneous Transluminal Angioplasty and Stenting in Arteriosclerosis Obliterans Patients

This study aimed to investigate the potential of serum Sirtuin 1 (SIRT1) and tissue inhibitor of metalloproteinase 3 (TIMP3) levels as biomarkers for in-stent restenosis (ISR) in arteriosclerosis obliterans (ASO) patients following percutaneous transluminal angioplasty (PTA) and stenting. A total of 256 ASO patients who underwent successful PTA with stent implantation were included. Serum levels of SIRT1 and TIMP3 were assessed at baseline and 4 weeks post-procedure. After 6 months, 65 patients were identified with ISR. Significant differences were noted in serum SIRT1 and TIMP3 levels between ISR and non-ISR groups at 4 weeks. TIMP3 had a higher AUC (0.782, 95% CI: 0.726-0.831) than SIRT1 (0.737, 95% CI: 0.678-0.789) for predicting ISR at 6 months. Correlation analysis showed a positive association between SIRT1 and TIMP3 levels in ISR patients at 4 weeks, but not in non-ISR patients. Multivariate analysis revealed diabetes (OR = 1.436, 95% CI: 1.205-1.925) and carotid stenosis (OR = 4.551, 95% CI: 1.364-15.185) significantly increased ISR risk, while lower SIRT1 (OR = 0.985, 95% CI: 0.978-0.992) and TIMP3 (OR = 0.574, 95% CI: 0.464-0.710) levels were significantly associated with ISR. Serum SIRT1 and TIMP3 levels at 4 weeks post-procedure are significant predictors of ISR in ASO patients following PTA and stenting. Lower SIRT1 and TIMP3 levels correlate with higher ISR risk. These findings suggest that monitoring serum SIRT1 and TIMP3 levels could be a valuable tool in predicting ISR, which could inform clinical decisions and patient management.

Plasma miR-21-5p and miRNA-93-5p Levels as Early Assessment Tools for In-Stent Restenosis Following Endovascular Stenting Treatment in Patients with Lower Extremity Atherosclerotic Disease

In-stent restenosis (ISR) still remains a leading cause of failure of interventional therapy in patients with lower extremity atherosclerotic disease (LEAD). Sensitive and reliable biomarkers to predict ISR should be identified. This study aims to investigate predictive values of two microRNAs, miR-21-5p and miR-93-5p for ISR following endovascular stenting treatment. A total of 128 LEAD patients receiving endovascular stenting treatment were included into the study and their restenotic status followed up by computed tomography angiography after 6 months to examine the incidence of ISR. The results of two-way ANOVAs showed a significant effect of ISR presence, time, and ISR × time interaction on the plasma level of miR-21-5p and miR-93-5p among LEAD patients, which reduced at the postoperative 14th day. The following multiple comparisons test showed higher plasma level of miR-21-5p and miR-93-5p at the postoperative 14th day in the ISR than the non-ISR (P < 0.0001). The plasma levels of miR-21-5p and miR-93-5p at 14 days after surgery used alone or combination as a test to predict ISR occurrence 6 months after surgery produced an AUC of 0.845, 0.839, and 0.906, respectively. Multiple logistic regression analysis revealed the plasma levels of miR-21-5p and miR-93-5p at 14 days after surgery were risk factors for LEAD patients developing ISR at 6 months after surgery (P < 0.001). Our results suggest that plasma miR-21-5p and miR-93-5p levels at 14 days after surgery may serve as potential biomarkers for developing ISR following endovascular stenting treatment among LEAD patients.

Association Between Thromboelastography and Coagulation for Disease Severity Evaluation in Patients With Lower Extremity Arteriosclerosis Obliterans

BACKGROUND

Thromboelastography (TEG) and coagulation tests can be used to detect hypercoagulability to assess thrombus formation. This study explored the association between TEG and coagulation in evaluating disease severity in elderly patients with lower extremity arteriosclerotic occlusive disease (LEASO), aimed to provide surgical treatment guideline.

METHODS

We retrospectively analyzed the clinical characteristics, laboratory biomarkers, TEG and coagulation parameters of 233 elderly LEASO patients treated between 2020 and 2023. Among them, 86 underwent surgical amputation, 51 received vascular intervention, and the remaining were treated conservatively. Differences in TEG and coagulation among the three groups were assessed using Spearman's correlation. Multivariate logistic regression and receiver operating characteristic curves analyzed the relationships among TEG, fibrinogen (FIB), and D-dimer (D-D) levels for surgical evaluation.

RESULTS

Inflammatory factors, platelet counts, and Fontaine stages III-IV differed significantly between the surgery and conservative groups (p < 0.05). The surgery group had higher α-angle, maximum amplitude (MA), coagulation comprehensive index (CI), FIB, and D-D, whereas lower clotting time (K) compared to the conservative group (p < 0.05), correlated with a lower ankle brachial index (ABI), indicating more severe clinical presentation. Spearman's analysis identified positive associations between α-angle, MA with FIB and D-D levels in surgical patients. Area under curve analysis indicated that combining MA, α-angle, FIB, and D-D could enhance accuracy in evaluating surgical necessity in LEASO.

CONCLUSION

In elderly LEASO patients, TEG and coagulation analysis revealed a positive association between thrombus intensity and disease severity. Increased MA, α-angle, FIB, and D-D levels serve as predictors for surgical treatment necessity in LEASO.

Clinical efficacy evaluation and safety study of Qishen Tongmai Yin I combined with moxibustion therapy on ASO: A retrospective study

This study aimed to assess the therapeutic efficacy of moxibustion assisted therapy in combination with Qishen Tongmai Yin No. 1 on arteriosclerosis obliterans (ASO) patients. The impact on clinical symptoms, sign scores, foot dorsum temperature, foot dorsum artery blood flow, and overall clinical efficacy were analyzed. Sixty-three ASO patients from Beijing Xiaotangshan Hospital and Beijing Shijitan Hospital (January 2020-December 2021) were divided into 3 groups: a Qi Shen Tong Mai Yin I-only group, a moxibustion-only group, and a combined treatment group receiving both moxibustion and Qi Shen Tong Mai Yin No. 1. The treatment group took Qi Shen Tong Mai Yin No. 1 orally 3 times daily for 1 month. Moxibustion, employing a mild method, was applied once daily for 35 minutes over a month. Key acupoints included bilateral kidney Shu, Guan Yuan, Ming Men, Zu San Li, Wei Zhong, San Yin Jiao, and Yao Yang Guan. Posttreatment, clinical symptom scores, and dorsum foot parameters were measured, including foot temperature and dorsum foot artery blood flow. Total effective and cure rates were calculated. Pretreatment, no significant differences existed among the 3 groups (P > .05). Posttreatment, the clinical efficacy, dorsalis pedis temperature, dorsalis pedis artery blood flow, and symptom scores significantly improved in all groups (P < .05). Differences in these indicators were also significant among the 3 groups (P < .05). Moxibustion assisted therapy combined with Qishen Tongmai Yin No. 1 enhances total effective and cure rates in ASO patients, improving foot temperature, blood flow, microcirculation, and overall clinical efficacy. Additionally, this combination reduces scores for intermittent claudication, pain, skin temperature, soreness, skin color, and numbness, mitigating disease progression. Safety evaluation indicated no adverse events during treatment, demonstrating the safety of the combined therapy.

[Construction of a risk prediction model for bronchiolitis obliterans in children with refractory Mycoplasma pneumoniae pneumonia]

OBJECTIVES

To explore the establishment of a risk prediction model for concurrent bronchiolitis obliterans (BO) in children with refractory Mycoplasma pneumoniae pneumonia (RMPP).

METHODS

A retrospective study included 116 RMPP children treated in the Department of Pediatrics of Xiangya Changde Hospital from June 2021 to December 2023. Eighty-one cases were allocated to the training set and thirty-five cases to the validation set based on a 7:3 ratio. Among them, 26 cases in the training set developed BO, while 55 did not. The multivariate logistic regression was used to select variable factors for constructing the BO risk prediction model. Nomograms were drawn, and the receiver operating characteristic (ROC) curve was used to assess the discriminative ability of the model, while calibration curves and Hosmer-Lemeshow tests evaluated the model's calibration.

RESULTS

Multivariate logistic regression analysis indicated that several factors were significantly associated with concurrent BO in RMPP children, including length of hospital stay, duration of fever, atelectasis, neutrophil percentage (NEUT%), peak lactate dehydrogenase (LDH), ferritin, peak C reactive protein (CRP), oxygenation index (PaO2/FiO2), ≥2/3 lung lobe consolidation, pleural effusion, bronchial mucous plugs, bronchial mucosal necrosis, and arterial oxygen partial pressure (PaO2) (P<0.05). ROC curve analysis for the training set indicated an area under the curve of 0.904 with 88% sensitivity and 83% specificity; the validation set showed an area under the curve of 0.823 with 76% sensitivity and 93% specificity. The Hosmer-Lemeshow test's Chi-square values for the training and validation sets were 2.17 and 1.92, respectively, with P values of 0.221 and 0.196, respectively.

CONCLUSIONS

The risk prediction model for BO in RMPP children based on logistic regression has good performance. Variables such as length of hospital stay, duration of fever, atelectasis, peak LDH, peak CRP, NEUT%, ferritin, ≥2/3 lung lobe consolidation, pleural effusion, bronchial mucous plugs, bronchial mucosal necrosis, PaO2/FiO2, andPaO2 can be used as predictors.

Predictive model for novel subtypes of patients undergoing lower extremity amputation for peripheral artery disease: An unsupervised machine learning study

Background

Peripheral artery disease (PAD) represents the frequently seen circulatory condition related to a risk of critical limb ischemia and amputation. Critical lower extremity ischemia may require amputation, and the outcomes vary. In this study, we developed an artificial intelligence (AI)-driven predictive model for PAD subtypes to assess risk among patients more precisely and accurately to predict disease progression.

Methods

The present retrospective study examined clinical data in PAD patents undergoing lower extremity amputation. The data were analyzed using an unsupervised machine learning algorithm (UMLA) for subgroup identification and risk stratification. The clustering result accuracy was validated by analyzing the follow-up data of clusters. Finally, we built the prediction model with binary logistic regression.

Results

In total, we enrolled 507 cases into this work. Two distinct subgroups, consisting of Clusters 1 and 2, were identified by UMLA; those from Cluster 1 showed markedly poorer conditions and prognostic outcomes compared with those from Cluster 2. With regard to the new PAD subtype, we established a nomogram with eight predictive factors, including gender, age, smoking history, diabetes and coronary heart disease history, albumin levels, endovascular intervention, and amputation level. The nomogram could accurately categorize patients into two identified clusters, and the area under receiver operating characteristic curve was 0.861 (95 % confidence interval: 0.830-0.893).

Conclusion

In this study, UMLA was used to identify new phenotypic subgroups among PAD cases who showed different risks of amputation. Our constructed AI-driven predictive model for PAD subtypes showed that it can be used for risk stratification and clinical management with high accuracy and reliability.

Construction of prediction models for novel subtypes in patients with arteriosclerosis obliterans undergoing endovascular therapy: an unsupervised machine learning study

BACKGROUND

Arteriosclerosis obliterans (ASO) is a chronic arterial disease that can lead to critical limb ischemia. Endovascular therapy is increasingly used for limb salvage in ASO patients, but the outcomes vary. The development of prediction models using unsupervised machine learning may lead to the identification of novel subtypes to guide patient prognosis and treatment.

METHODS

This retrospective study analyzed clinical data from 448 patients with ASOs who underwent endovascular therapy. Unsupervised machine learning algorithms were employed to identify subgroups. To validate the precision of the clustering outcomes, an analysis of the postoperative results of the clusters was conducted. A prediction model was constructed using binary logistic regression.

RESULTS

Two distinct subgroups were identified by unsupervised machine learning and characterized by differing patterns of clinical features. Patients in Cluster 2 had significantly worse conditions and prognoses than those in Cluster 1. For the novel ASO subtypes, a nomogram was developed using six predictive factors, namely, platelet count, ankle brachial index, Rutherford category, operation method, hypertension, and diabetes status. The nomogram achieved excellent discrimination for predicting membership in the two identified clusters, with an area under the curve of 0.96 and 0.95 in training cohort and internal test cohort.

CONCLUSION

This study demonstrated that unsupervised machine learning can reveal novel phenotypic subgroups of patients with varying prognostic risk who underwent endovascular therapy. The prediction model developed could support clinical decision-making and risk counseling for this complex patient population. Further external validation is warranted to assess the generalizability of the findings.

Curcumol reduces lower limb arteriosclerosis in rats by inhibiting human arterial smooth muscle cell activity

Cardiovascular diseases, particularly those involving arterial stenosis and smooth muscle cell proliferation, pose significant health risks. This study aimed to investigate the therapeutic potential of curcumol in inhibiting platelet-derived growth factor-BB (PDGF-BB)-induced human aortic smooth muscle cell (HASMC) proliferation, migration and autophagy. Using cell viability assays, 5-ethynyl-2'-deoxyuridine (EdU) incorporation assays and Western Blot analyses, we observed that curcumol effectively attenuated PDGF-BB-induced HASMC proliferation and migration in a concentration-dependent manner. Furthermore, curcumol mitigated PDGF-BB-induced autophagy, as evidenced by the downregulation of LC3-II/LC3-I ratio and upregulation of P62. In vivo experiments using an arteriosclerosis obliterans model demonstrated that curcumol treatment significantly ameliorated arterial morphology and reduced stenosis. Additionally, curcumol inhibited the activity of the KLF5/COX2 axis, a key pathway in vascular diseases. These findings suggest that curcumol has the potential to serve as a multi-target therapeutic agent for vascular diseases.

Construction of a novel lower-extremity peripheral artery disease subtype prediction model using unsupervised machine learning and neutrophil-related biomarkers

Lower-extremity peripheral artery disease (LE-PAD) is a prevalent circulatory disorder with risks of critical limb ischemia and amputation. This study aimed to develop a prediction model for a novel LE-PAD subtype to predict the severity of the disease and guide personalized interventions. Additionally, LE-PAD pathogenesis involves altered immune microenvironment, we examined the immune differences to elucidate LE-PAD pathogenesis. A total of 460 patients with LE-PAD were enrolled and clustered using unsupervised machine learning algorithms (UMLAs). Logistic regression analyses were performed to screen and identify predictive factors for the novel subtype of LE-PAD and a prediction model was built. We performed a comparative analysis regarding neutrophil levels in different subgroups of patients and an immune cell infiltration analysis to explore the associations between neutrophil levels and LE-PAD. Through hematoxylin and eosin (H&E) staining of lower-extremity arteries, neutrophil infiltration in patients with and without LE-PAD was compared. We found that UMLAs can helped in constructing a prediction model for patients with novel LE-PAD subtypes which enabled risk stratification for patients with LE-PAD using routinely available clinical data to assist clinical decision-making and improve personalized management for patients with LE-PAD. Additionally, the results indicated the critical role of neutrophil infiltration in LE-PAD pathogenesis.

Effect of alprostadil plus cilostazol on the treatment outcomes and inflammatory factors in patients with lower extremity arteriosclerosis obliterans receiving evidence-based care

This study aims to elucidate the effect of alprostadil (ALP) plus cilostazol (CIL) on the treatment outcomes and inflammatory factors in patients with lower extremity arteriosclerosis obliterans (LEASO) receiving evidence-based care. Firstly, 130 patients with LEASO were selected from February 2020 to February 2023 and then randomly divided into two groups with 65 patients each. Excluding the dropouts, 59 patients in the control group (6 cases of dropout) received ALP and 62 patients in the research group (3 cases of dropout) received ALP plus CIL. Both groups were cared for in accordance with the evidence-based care model. Treatment outcomes, arteriosclerosis indexes (blood flow of dorsalis pedis artery [DPA], ankle-brachial index [ABI] and toe-brachial index [TBI]), hemorheological parameters (erythrocyte aggregation index [EAI], erythrocyte deformation index [EDI], high blood viscosity [HBV] and haematocrit [HCT]), inflammatory factors (interleukin [IL]-6, IL-8 and tumour necrosis factor [TNF]-α) and complications (nausea, diarrhoea, headache and transaminase elevation) were compared between the control and research groups. Results show that the overall response rate was markedly higher in the research group (90.32%) than in the control group (74.58%). Additionally, the blood flow of DPA, ABI and TBI in the research group significantly increased after the treatment and were higher than those in the control group. Meanwhile, the EAI, EDI, HBV, HCT, IL-6, IL-8 and TNF-α were significantly lower. The two groups did not differ markedly in the complication rate. The above findings suggest that ALP plus CIL is effective for patients with LEASO receiving evidence-based care. It can significantly improve arteriosclerosis indexes and hemorheological parameters while inhibiting serum inflammatory responses, with some certain safety.

MicroRNA-30a-3p: a potential noncoding RNA target for the treatment of arteriosclerosis obliterans

An increasing number of studies have shown that noncoding RNAs are involved in cardiovascular diseases. Our study shows that the expression of microRNA-30a-3p (miR-30a-3p) in patients with arteriosclerosis obliterans (ASO) of the lower extremities is significantly decreased after endovascular treatment, but its role is unclear. This study aims to explore the role of microRNA-30a-3p in ASO and its related mechanisms. Immunofluorescence and in situ hybridization costaining indicated that microRNA-30a-3p mostly exists in vascular smooth muscle cells (VSMCs). Furthermore, after transfection into VSMCs, microRNA-30a-3p inhibited VSMC proliferation, migration and phenotype switching. In addition, luciferase reporter and western blot analyses indicated that ROCK2 (Rho-related spiral coil 2 containing protein kinase) is a microRNA-30a-3p target gene, and participates in the microRNA-30a-3p mediated cell inhibitory effect. At last, the rat carotid artery was infected by lentivirus after balloon injury, which increased microRNA-30a-3p levels and apparently suppressed the formation of neointima in vivo. Overall, exogenous introduction of microRNA-30a-3p, a noncoding RNA with unlimited potential, may be a new approach to treat ASO.

Status and influencing factors of frailty in patients with restenosis after percutaneous transluminal angioplasty for peripheral arterial disease: A cross-sectional study

This study aimed to investigate the frailty of patients with restenosis after percutaneous transluminal angioplasty (PTA) for peripheral arterial disease, explore the influencing factors, and determine its key factors to take targeted care measures and provide a basis for further interventional care. We recruited as many eligible subjects as possible and a total of 106 patients with restenosis after PTA for peripheral arterial disease in our hospital finished this study from January 2016 to August 2021. The Shorter 12-item version of health-related quality of life scale, Chinese Tilburg debility scale, Pittsburgh sleep quality index scale and activities of daily living score scale were used for investigation, and the independent influencing factors of patients' frailty were evaluated by multivariate logistic regression analysis. The incidence of frailty in restenosis after PTA was 72.6%. Logistic regression analysis found that high levels of C-reactive protein (odds ratios [OR] = 1.080, 95% confidence interval [CI] 1.012-1.153), diabetes (OR = 2.531, 95% CI 1.024-6.257) and advanced age (OR = 1.170, 95% CI 1.042-1.314) were risk factors for restenosis patients frailty, and higher scores of shorter 12-item version of health-related quality of life scale (OR = 0.889, 95% CI 0.813-0.973) was a protective factor for frailty in these patients. The incidence of debilitation in patients with restenosis after PTA for peripheral arterial disease is high, and high C-reactive protein levels, diabetes mellitus and advanced age are significantly associated with restenosis patients. Improving the quality of life of restenosis patients can reduce the occurrence of frailty.

Multislice Computed Tomography Angiography Imaging Diagnosis of Lower Extremity Arteriosclerosis in Patients with Hypertension and Its Correlation with the Level of High-Sensitivity C-Reactive Protein

The aim of this study was to investigate the relationship between multislice computed tomography (CT) angiography (MSCTA) imaging and high-sensitivity C-reactive protein (hs-CRP) in patients with hypertension and lower extremity arteriosclerosis. 68 hypertensive patients with lower extremity arteriosclerosis were selected as the observation group, and 68 healthy volunteers were selected as the control group to compare the differences in hs-CRP. According to the degree of stenosis, the patients were further divided into five grades: no obvious stenosis, mild stenosis, moderate stenosis, severe stenosis, and occlusion. The correlation between the degree of stenosis and the content of hs-CRP was compared. The changes of hs-CRP content before and after treatment were compared, and the difference of images before and after surgical treatment and the difference of hs-CRP expression in patients with occlusion were compared. Compared with the control group, the content of hs-CRP in the observation group was significantly higher ( $P<0.05$ ), and the degree of stenosis was positively correlated with the content of hs-CRP. After two weeks of treatment, the hs-CRP levels of patients with severe stenosis and occlusion were significantly lower than those before treatment ( $P<0.01$ ). The level of hs-CRP in patients with occlusion after arterial stent intervention was significantly lower than before, and the images also showed that the blood vessels were significantly expanded. The degree of stenosis in patients with lower extremity arteriosclerosis diagnosed by MSCTA imaging was closely related to the expression of hs-CRP in the patient, and a sustained high concentration of hs-CRP corresponded to a more severe degree of vascular occlusion. In conclusion, the hs-CRP can be used as one of the factors to predict and evaluate the occurrence of cardiovascular and cerebrovascular diseases.

Ruan Jian Qing Mai Recipe Inhibits the Inflammatory Response in Acute Lower Limb Ischemic Mice through the JAK2/STAT3 Pathway

Ruan jian qing mai recipe (RJQM) is an empirical prescription for treating arteriosclerosis obliterans (ASO). However, the mechanism of RJQM recipe-mediated ASO attenuation has not yet been elucidated. Therefore, this study aimed to explore the mechanism by which the RJQM recipe relieves ASO in a mouse model of lower limb ischemia, which was established by ligating and breaking the femoral artery of the left lower limb. The surgical groups were divided into the ischemic group, beraprost sodium group, low-dose RJQM group, medium-dose RJQM group, and high-dose RJQM group. Normal mice were set as the control group. The blood flow of the lower limb was examined on days 7 and 14. At the end of animal procedures, blood samples were collected, and the rectus femoris of the left lower limb were harvested. Results revealed that mice in the ischemic group demonstrated low blood flow. Additionally, hematoxylin and eosin, and Masson staining results showed that inflammation of the rectus femoris was obvious in the ischemia group, and the level of fibrosis was increased. Blood flow was recovered in all treatment groups compared to the ischemic group, and the inflammatory infiltration and fibrosis of the rectus femoris were relieved after RJQM treatment. The serum levels of interleukin (IL)-17A and IL-21 were decreased, and the expression of JAK2/STAT3 proteins was inhibited in all RJQM treatment groups compared to the ischemia group. Furthermore, the improvement of IL-17A, IL-21, and rectus femoris fibrosis was more obvious with increasing treatment time. In conclusion, RJQM can effectively alleviate ASO and promote the recovery of lower limb blood flow by regulating the JAK2/STAT3 signaling pathway to reduce the inflammatory response.

Clinical Efficacy of Interventional Therapy on Lower Extremity Arteriosclerosis Obliterans and Prognostic Factors

Objective

This study was designed to analyse the clinical efficacy of interventional therapy on lower extremity arteriosclerosis obliterans (LEASO) and prognostic factors.

Methods

A total of 122 patients with LEASO diagnosed in our hospital from March 2017 to March 2019 were retrospectively analysed. Among them, 72 patients who received conservative therapy were assigned to a conservative group, and 50 patients who received interventional therapy additionally based on conservative therapy were assigned to an intervention group. The short-term (12 weeks after therapy) and long-term (3 years after therapy) clinical efficacies on the two groups were compared. Death, amputation, and vascular restenosis (vascular stenosis > 50% in computed tomography reexamination) were defined as unfavourable outcomes, and Cox regression was conducted to analyze the factors influencing the prognosis of patients. The incidence of adverse events in the two groups within 3 years was compared and statistically analyzed. Additionally, the hospital stay, therapy cost, claudication distance, and ankle brachial index were compared between the two groups.

Results

After therapy, the conservative group showed a notably lower total effective rate than the intervention group (P < 0.05), but the clinical efficacy after 3 years was similar between the two groups (P > 0.05). Additionally, the conservative group experienced notably longer hospital stay than the intervention group (P < 0.05), and cost less in treatment than the intervention group (P < 0.05). However, the conservative group experienced a notably shorter claudication distance and showed a notably lower ankle brachial index than the intervention group (P < 0.05). The two groups were not significantly different in mortality, amputation rate, and vascular restenosis rate (P > 0.05). Moreover, Cox regression analysis revealed that age and conservative therapy were independent risk factors for the prognosis of patients (P < 0.05).

Conclusion

Interventional therapy can substantially improve the short-term efficacy and prognosis of patients with LEASO, but the cost is high, so the therapeutic regimen should be selected according to the patient's economic condition.

Ultrasonic Image Feature Analysis under Deep Learning Algorithm to Evaluate the Efficacy of Drug-Coated Balloon for Treatment of Arteriosclerotic Occlusion

In order to explore the adoption of ultrasonic images under deep learning (DL) algorithm to evaluate the efficacy of drug-coated balloon (DCB) for treatment of arteriosclerotic occlusion, 56 patients who underwent DCB surgery of lower limb artery were selected and all the patients received the examinations of algorithmic ultrasound and digital subtraction angiography (DSA) before surgery. According to the examination methods, they were classified into algorithmic ultrasound group and DSA group. One to two months after DCB surgery, ultrasound examination was performed with the region-based faster convolutional neural network (faster R-CNN) target detection algorithm to check the therapeutic effect. The results showed that the image effect processed by the target detection algorithm based on DL was signally better than that of traditional ultrasonic processing algorithm in Dice, precision (Pre), and sensitivity, with significant difference (P < 0.05). Compared with DSA, algorithmic ultrasound showed better consistency between the two groups in the diagnosis of common femoral artery, superficial femoral artery, and popliteal artery stenosis, with statistical significance (P < 0.05). However, for the diagnosis of anterior tibial artery stenosis, the consistency between algorithmic ultrasound and DSA was general. The residual stenosis of each artery segment decreased obviously in postoperative review compared with that before surgery, and the difference was statistically significant (P < 0.05). Besides, both the pulsatility index (PI) and the blood flow velocity of the dorsalis pedis artery increased after surgery, compared with those before surgery, with significant differences (P < 0.05). To sum up, ultrasound based on DL target detection algorithm had good imaging effect and good consistency with DSA, which was of the clinical reference value. Additionally, DCB surgery was helpful to treat arteriosclerosis occlusion and improve limb blood supply, which had clinical adoption value.