Diagnosis of Arteriosclerosis Obliterans of Lower Extremity in Early Stage_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LU Jingbo , LIU Zhengjun , LIN Zhiqi.

Department of Vascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China;

Corresponding?author：

Keywords：

Atherosclerosis; Arteriosclerosis obliterans of lower extremity; Early diagnosis; Artery detection; Ankle brachial index

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Objective To explore the methods of early diagnosis of arteriosclerosis obliterans of lower extremity (ASOLE). Methods The related literatures on ASOLE detection means adopted clinically were reviewed, and their advantages and disadvantages were compared.
Results Asymptomatic ASOLE could be discovered by determination of ankle brachial index (ABI) and toe brachial index (TBI), which was a good index for arterial function assessment of lower extremity. Pulse wave velocity (PWV) was more vulnerable and less sensitive than ABI, and therefore more suitable for screening of a large sample. ASI was an index to assess arterial structure and function, and it had a good correlation with PWV. Flow-mediated dilation (FMD) was a measurement evaluating the function of endothelial cell; Pulse wave measurement was simple, sensitive, and its result was reliable. Color Doppler ultrasonography could localizate the lesion and determine the degree of stenosis at the same time. Multiple-slice CT angiography (MSCTA) was more accurate than color Doppler ultrasonography, but its inherent shortcomings, such as nephrotoxicity of contrast agent, was still need to be resolved. 3D-contrast enhancement magnetic resonance angiography (CEMRA) had little nephrotoxicity, but a combination of other imaging methods was necessary. Microcirculation detections required high consistency of the measurement environment, but they were simple, sensitive and noninvasive, and therefore could be used for screening of ASO.
Conclusion Publicity and education of highrisk groups, and reasonable selection of all kinds of detection means, are helpful to improve the early diagnosis of ASOLE.

Citation： LU Jingbo,LIU Zhengjun,LIN Zhiqi.. Diagnosis of Arteriosclerosis Obliterans of Lower Extremity in Early Stage. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(7): 690-693. doi: Copy

1.	王玉琦, 史振宇. 我國血管外科的現狀與展望 [J]. 中國普外基礎與臨床雜志, 2008; 15(6): 387389.
2.	陳斌, 董智慧, 符偉國, 等. 性別對下肢動脈硬化性閉塞癥的影響分析 [J]. 中華外科雜志, 2008; 46(7): 534536.
3.	管珩, 劉志民, 李光偉, 等. 50歲以上糖尿病人群周圍動脈閉塞性疾病相關因素分析 [J]. 中華醫學雜志, 2007; 87(1): 2327.
4.	Mutirangura P, Ruangsetakit C, Wongwanit C, et al. Atherosclerosis obliterans of the lower extremities in Thai patients [J]. J Med Assoc Thai, 2006; 89(10): 16121620.
5.	Zhou J, Austin RC. Contributions of hyperhomocysteinemia to atherosclerosis: Causal relationship and potential mechanisms [J]. Biofactors, 2009; 35(2): 120129.
6.	Utsumi K, Kawabe M, Hirama A, et al. Effects of selective LDL apheresis on plasma concentrations of ICAM1, VCAM1 and Pselectin in diabetic patients with arteriosclerosis obliterans and receiving maintenance hemodialysis [J]. Clin Chim Acta, 2007; 377(12): 198200.
7.	趙泉, 鄧靖宇, 羅開元, 等. 血管內皮細胞在動脈粥樣硬化中的損傷機理 [J]. 中國普外基礎與臨床雜志, 2004; 11(4): 325327.
8.	Shval’b PG, Kalinin RE. Antioxidant activity and functional endothelium characteristics before and after the operation in patients with atherosclerosis obliterans [J]. Khirurgiia (Mosk), 2009; (1): 5355.
9.	Shval’b PG, Kalinin RE. Certain biochemical alterations in the blood of patients with atherosclerosis obliterans of the lower limb arteries [J]. Angiol Sosud Khir, 2007; 13(3): 3437.
10.	Iskra M, Barakiewicz D, Majewski W, et al. Serum magnesium, copper and zinc concentration changes in lower limb ischemia and postoperative treatment [J]. Magnes Res, 2005; 18(4): 261267.
11.	Fleck CA. Measuring ankle brachial pressure index [J]. Adv Skin Wound Care, 2007; 20(12): 645646, 648649.
12.	MacDonald E, Froggatt P, Lawrence G, et al. Are automated blood pressure monitors accurate enough to calculate the ankle brachial pressure index? [J]. J Clin Monit Comput, 2008; 22(5): 381384.
13.	Mukherjee D, Cho L. Peripheral arterial disease: considerations in risks, diagnosis, and treatment [J]. J Natl Med Assoc, 2009; 101(10): 9991008.
14.	Nichols WW, Denardo SJ, Wilkinson IB, et al. Effects of arterial stiffness, pulse wave velocity, and wave reflections on the central aortic pressure waveform [J]. J Clin Hypertens (Greenwich), 2008; 10(4): 295303.
15.	Noon JP. The arterial pulse wave and vascular compliance [J]. Prog Cardiovasc Nurs, 2009; 24(2): 5358.
16.	Khoshdel AR, Carney SL, Nair BR, et al. Better management of cardiovascular diseases by pulse wave velocity: combining clinical practice with clinical research using evidencebased medicine [J]. Clin Med Res, 2007; 5(1): 4552.
17.	DeLoach SS, Townsend RR. Vascular stiffness: its measurement and significance for epidemiologic and outcome studies [J]. Clin J Am Soc Nephrol, 2008; 3(1): 184192.
18.	Liu Z, Hesse C, Curry TB, et al. Ambulatory arterial stiffness index is not correlated with the pressor response to laboratory stressors in normotensive humans [J]. J Hypertens, 2009; 27(4): 763768.
19.	Safar ME. Pulse pressure, arterial stiffness and wave reflections (augmentation index) as cardiovascular risk factors in hypertension [J]. Ther Adv Cardiovasc Dis, 2008; 2(1): 1324.
20.	Celermajer DS, Sorensen KE, Gooch VM, et al. Noninvasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis [J]. Lancet, 1992; 340(8828): 11111115.
21.	Korkmaz H, Onalan O. Evaluation of endothelial dysfunction: flowmediated dilation [J]. Endothelium, 2008; 15(4): 157163.
22.	Barbeau GR, Arsenault F, Dugas L, et al. Evaluation of the ulnopalmar arterial arches with pulse oximetry and plethysmography: comparison with the Allen’s test in 1 010 patients [J]. Am Heart J, 2004; 147(3): 489493.
23.	高海青. 動脈功能早期檢測技術的臨床應用前景 [J]. 中華老年醫學雜志, 2007; 26(5): 325327.
24.	劉艷萍. 下肢動脈粥樣硬化性閉塞癥的彩色多普勒超聲診斷價值 [J]. 實用心腦肺血管病雜志, 2008; 16(5): 4445.
25.	Watanabe R, Nakanishi K, Ochi S, et al. Assessment of lower limb artery disease by ultrasound imaging [J]. Rinsho Byori, 2007; 55(2): 159169.
26.	NguyenThanh HT, Benzaquen BS. Screening for subclinical coronary artery disease measuring carotid intima media thickness [J]. Am J Cardiol, 2009; 104(10): 13831388.
27.	Ogasawara N, Komatsu S, Ropers D, et al. Detecting vulnerable plaque of arteriosclerosis obliterans by multidetectorrow computed tomography－comparing with VH (virtual histology)intravascular ultrasound [J]. Int J Cardiol, 2008; 127(2): e33e35.
28.	袁飛, 劉銀社, 董少義, 等. 64層螺旋CT對下肢動脈硬化閉塞癥的診斷價值 [J]. 中國醫學影像技術, 2008; 24(11): 17671770.
29.	Yu T, Zhu X, Tang L, et al. Review of CT angiography of aorta [J]. Radiol Clin North Am, 2007; 45(3): 461483, viii.
30.	蘭文婧, 谷艷英, 王大偉, 等. 3DCEMRA在下肢動脈硬化閉塞癥中的診斷價值 [J]. 中國老年學雜志, 2006; 26(7): 882884.
31.	Debrey SM, Yu H, Lynch JK, et al. Diagnostic accuracy of magnetic resonance angiography for internal carotid artery disease: a systematic review and metaanalysis [J]. Stroke, 2008; 39(8): 22372248.
32.	Yamada T, Ohta T, Ishibashi H, et al. Clinical reliability and utility of skin perfusion pressure measurement in ischemic limbs-comparison with other noninvasive diagnostic methods [J]. J Vasc Surg, 2008; 47(2): 318323.
33.	劉亮, 李小鷹, 趙秀梅, 等. 激光多普勒血流圖像儀檢測老年下肢動脈硬化閉塞癥的臨床療效 [J]. 中華老年心腦血管病雜志, 2003; 5(6): 368370.
34.	劉亮, 李小鷹, 曹劍, 等. 甲襞微循環綜合定量法評價前列腺素E1對老年下肢動脈硬化閉塞癥的臨床療效 [J]. 軍醫進修學院學報, 2005; 26(3): 196197.
35.	Sugimoto I, Ohta T, Ishibashi H, et al. Transcutaneous carbon dioxide tension for the evaluation of limb ischemia [J]. Surg Today, 2009; 39(1): 913.

1. 王玉琦, 史振宇. 我國血管外科的現狀與展望 [J]. 中國普外基礎與臨床雜志, 2008; 15(6): 387389.
2. 陳斌, 董智慧, 符偉國, 等. 性別對下肢動脈硬化性閉塞癥的影響分析 [J]. 中華外科雜志, 2008; 46(7): 534536.
3. 管珩, 劉志民, 李光偉, 等. 50歲以上糖尿病人群周圍動脈閉塞性疾病相關因素分析 [J]. 中華醫學雜志, 2007; 87(1): 2327.
4. Mutirangura P, Ruangsetakit C, Wongwanit C, et al. Atherosclerosis obliterans of the lower extremities in Thai patients [J]. J Med Assoc Thai, 2006; 89(10): 16121620.
5. Zhou J, Austin RC. Contributions of hyperhomocysteinemia to atherosclerosis: Causal relationship and potential mechanisms [J]. Biofactors, 2009; 35(2): 120129.
6. Utsumi K, Kawabe M, Hirama A, et al. Effects of selective LDL apheresis on plasma concentrations of ICAM1, VCAM1 and Pselectin in diabetic patients with arteriosclerosis obliterans and receiving maintenance hemodialysis [J]. Clin Chim Acta, 2007; 377(12): 198200.
7. 趙泉, 鄧靖宇, 羅開元, 等. 血管內皮細胞在動脈粥樣硬化中的損傷機理 [J]. 中國普外基礎與臨床雜志, 2004; 11(4): 325327.
8. Shval’b PG, Kalinin RE. Antioxidant activity and functional endothelium characteristics before and after the operation in patients with atherosclerosis obliterans [J]. Khirurgiia (Mosk), 2009; (1): 5355.
9. Shval’b PG, Kalinin RE. Certain biochemical alterations in the blood of patients with atherosclerosis obliterans of the lower limb arteries [J]. Angiol Sosud Khir, 2007; 13(3): 3437.
10. Iskra M, Barakiewicz D, Majewski W, et al. Serum magnesium, copper and zinc concentration changes in lower limb ischemia and postoperative treatment [J]. Magnes Res, 2005; 18(4): 261267.
11. Fleck CA. Measuring ankle brachial pressure index [J]. Adv Skin Wound Care, 2007; 20(12): 645646, 648649.
12. MacDonald E, Froggatt P, Lawrence G, et al. Are automated blood pressure monitors accurate enough to calculate the ankle brachial pressure index? [J]. J Clin Monit Comput, 2008; 22(5): 381384.
13. Mukherjee D, Cho L. Peripheral arterial disease: considerations in risks, diagnosis, and treatment [J]. J Natl Med Assoc, 2009; 101(10): 9991008.
14. Nichols WW, Denardo SJ, Wilkinson IB, et al. Effects of arterial stiffness, pulse wave velocity, and wave reflections on the central aortic pressure waveform [J]. J Clin Hypertens (Greenwich), 2008; 10(4): 295303.
15. Noon JP. The arterial pulse wave and vascular compliance [J]. Prog Cardiovasc Nurs, 2009; 24(2): 5358.
16. Khoshdel AR, Carney SL, Nair BR, et al. Better management of cardiovascular diseases by pulse wave velocity: combining clinical practice with clinical research using evidencebased medicine [J]. Clin Med Res, 2007; 5(1): 4552.
17. DeLoach SS, Townsend RR. Vascular stiffness: its measurement and significance for epidemiologic and outcome studies [J]. Clin J Am Soc Nephrol, 2008; 3(1): 184192.
18. Liu Z, Hesse C, Curry TB, et al. Ambulatory arterial stiffness index is not correlated with the pressor response to laboratory stressors in normotensive humans [J]. J Hypertens, 2009; 27(4): 763768.
19. Safar ME. Pulse pressure, arterial stiffness and wave reflections (augmentation index) as cardiovascular risk factors in hypertension [J]. Ther Adv Cardiovasc Dis, 2008; 2(1): 1324.
20. Celermajer DS, Sorensen KE, Gooch VM, et al. Noninvasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis [J]. Lancet, 1992; 340(8828): 11111115.
21. Korkmaz H, Onalan O. Evaluation of endothelial dysfunction: flowmediated dilation [J]. Endothelium, 2008; 15(4): 157163.
22. Barbeau GR, Arsenault F, Dugas L, et al. Evaluation of the ulnopalmar arterial arches with pulse oximetry and plethysmography: comparison with the Allen’s test in 1 010 patients [J]. Am Heart J, 2004; 147(3): 489493.
23. 高海青. 動脈功能早期檢測技術的臨床應用前景 [J]. 中華老年醫學雜志, 2007; 26(5): 325327.
24. 劉艷萍. 下肢動脈粥樣硬化性閉塞癥的彩色多普勒超聲診斷價值 [J]. 實用心腦肺血管病雜志, 2008; 16(5): 4445.
25. Watanabe R, Nakanishi K, Ochi S, et al. Assessment of lower limb artery disease by ultrasound imaging [J]. Rinsho Byori, 2007; 55(2): 159169.
26. NguyenThanh HT, Benzaquen BS. Screening for subclinical coronary artery disease measuring carotid intima media thickness [J]. Am J Cardiol, 2009; 104(10): 13831388.
27. Ogasawara N, Komatsu S, Ropers D, et al. Detecting vulnerable plaque of arteriosclerosis obliterans by multidetectorrow computed tomography－comparing with VH (virtual histology)intravascular ultrasound [J]. Int J Cardiol, 2008; 127(2): e33e35.
28. 袁飛, 劉銀社, 董少義, 等. 64層螺旋CT對下肢動脈硬化閉塞癥的診斷價值 [J]. 中國醫學影像技術, 2008; 24(11): 17671770.
29. Yu T, Zhu X, Tang L, et al. Review of CT angiography of aorta [J]. Radiol Clin North Am, 2007; 45(3): 461483, viii.
30. 蘭文婧, 谷艷英, 王大偉, 等. 3DCEMRA在下肢動脈硬化閉塞癥中的診斷價值 [J]. 中國老年學雜志, 2006; 26(7): 882884.
31. Debrey SM, Yu H, Lynch JK, et al. Diagnostic accuracy of magnetic resonance angiography for internal carotid artery disease: a systematic review and metaanalysis [J]. Stroke, 2008; 39(8): 22372248.
32. Yamada T, Ohta T, Ishibashi H, et al. Clinical reliability and utility of skin perfusion pressure measurement in ischemic limbs-comparison with other noninvasive diagnostic methods [J]. J Vasc Surg, 2008; 47(2): 318323.
33. 劉亮, 李小鷹, 趙秀梅, 等. 激光多普勒血流圖像儀檢測老年下肢動脈硬化閉塞癥的臨床療效 [J]. 中華老年心腦血管病雜志, 2003; 5(6): 368370.
34. 劉亮, 李小鷹, 曹劍, 等. 甲襞微循環綜合定量法評價前列腺素E1對老年下肢動脈硬化閉塞癥的臨床療效 [J]. 軍醫進修學院學報, 2005; 26(3): 196197.
35. Sugimoto I, Ohta T, Ishibashi H, et al. Transcutaneous carbon dioxide tension for the evaluation of limb ischemia [J]. Surg Today, 2009; 39(1): 913.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Diagnosis of Arteriosclerosis Obliterans of Lower Extremity in Early Stage

Abstract Full text Figures/Tables Video References Cited by

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