MINISTRY OF EDUCATION AND TRAINING MINISTRY OF DEFENCE
108 INSTITUTE OF CLINICAL MEDICAL AND PHARMACEUTICAL SCIENCES
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LUONG TUAN ANH
THE CLINICAL CHARACTERISTICS ANDEFFICACY
OFINFRAPOPLITEAL PERCUTANEOUS
TRANSLUMINAL ANGIOPLASTY IN PATIENT WITH
LOWER EXTREMITY ARTERIAL DISEASE
Speciality: Cardiology
Code: 62.72.01.41
ABSTRACT OF MEDICAL PHD THESIS
Hanoi – 2019
THE THESIS WAS DONE IN:108 INSTITUTE OF CLINICAL
MEDICAL AND PHARMACEUTICAL SCIENCES
Supervisor:
1. Ass.Prof.PhD. Le Van Truong
2. Ass.Prof.PhD. Vu Dien Bien
Reviewer:
1.
2.
3.
This thesis will be presented at Institute Council at:108 Institute of
Clinical Medical and Pharmaceutical Sciences
Day Month Year 2019
The thesis can be found at:
1. National Library of Vietnam
2. Library of 108 Institute of Clinical Medical and
Pharmaceutical Sciences
1
INTRODUCTION
Lower extremity arterial disease (LEAD) is very common,
prevalence 3-7% of the population, 20% in people over 75 years old.
Ulcers and gangrenelower limb is the end- stages of the disease,
threatened amputation, loss of limb functiondue to infrapopliteal
arterial lesions. Below the knee revascularizationis the most
important in limb salvage for this disease.
There are two methods of infrapopliteal arterial
revascularization: bypass surgery and percutaneous angioplasty, so
bypass surgery is difficult due to below the knee artery small, long
lesions, bad run-off, elderly patients, many serious diseases
combined. Percutaneous transluminal angioplasty (PTA)is becoming
as important treatments for this area.
Currently LEAD with infrapopliteal lesions was concerned,
innitial step was deployed in Vietnam, yet researchs on medium and
long-term effectiveness, small sizes, should we proceed subject with
two purposes:
1. Study on clinical characteristics of lower extemity arterial
disease with infrapopliteal lesions.
2. Evaluate mid-term outcomes and factors influencing clinical
outcomes of infrapopliteal angioplasty in patient with lower
extremity arterial disease.
2
Chapter 1
OVERVIEW
1.1. LEAD Concept
Lower extremity arterial disease (LEAD) is only partially or
entirely in the lower limbs is not provided with adequate blood,
responding to physiological activities, with a duration of time
more than two weeks. This concept excludes acute limb
ischemia, vessel wounds, vascular complications.
The cause of LEAD is the development of atherosclerotic
plaques, which cause a narrowing or complete blockage of the
limb vessels.
Below the knee (BTK) arteriesincludes tibial artery (aterior
tibial artery, posterior tibial artery, peroneal artery), pedal artery
(dorsal pedal artery, medial plantar artery, lateral plantar artery).
1.2. Clinical Characteristics of LEAD
LEAD progresses through several stages, from asymptomatic,
claudication, rest pain, ulcer and gangrene. Critical limb ischemia
(CLI, including rest pain, ulcer and gangrene lower limb) with
infrapopliteal arterial lesion, considered the end stage of the LEAD,
threaten to limb losss.
LEAD is a common chronic cardiovascular disease caused by
atherosclerosis, with coronary artery disease and stroke, the
prevalence of 3-7% of the population (20% in people over 70 years of
age), of which the rate of CLI is 1 % population.
Common risk factors of LEAD are elderly age (> 50 years),
smoking, diabetes, hypertension, and dyslipidemia.
3
Table 1.2. Rutherford classification of PAD
Grade
Category
Clinical
0 0 Asymptomatic
I 1 Mild claudication
I 2 Moderate claudication
I 3 Severe claudication
II 4 Rest pain
III 5 Minor tissue loss
IV 6 Major tissue loss
1.3. LEAD Diagnostics
Hemodynamic tests Imaging Diagnostics
ABI index
TBI index
Treadmill test
Segmental systolic pressure
TcPO2, SPP
Doppler and Duplex Ultrasound
CTA
MRA
Angiography
In which the diagnostics tests are used in Vietnam are measuring
ABI index, ultrasound of lower extremities arterial lesions, CTA
before percutaneous transluminal angioplasty, and angiography in
intervention procedure.
1.4. PTA of LEAD with Infrapopliteal lesions
1.4.1. Treatment Purposes
+ Reduce symptoms of limb ischemia.
+ Limb salvage.