Comparative Study of Compression Bandages with Absolute Bed Rest versus Ambulation inTreatment of Acute Proximal Deep Vein Thrombosis

Background: In general, many patients with acute proximal deep vein thrombosis (DVT) are treated with heparin and oral anticoagulant. Many physicians have been taught to admit these patients to absolute bed rest for the first 24-48 hours due to the fear of dislodging clots that may lead to fatal pulmonary embolism (PE). Objective: The aim of this study is to compare the differences among the changing circumference of affected limb, the severity of pain, and the incidence of symptomatic PE in 3 groups of acute proximal DVT, including absolute bed rest with compression bandages (group 1), ambulation with compression bandages (group 2), and ambulation without compression bandages (group 3). Methods: Between January 2006 and March 2011, 60 patients were enrolled in this study. In this analysis, the clinical characteristics, the changes of affected limb circumference and pain score during the first week of admis- sion and the incidence of symptomatic PE among 3 groups of this study were analyzed. Results: There were no statistical differences in the characteristics among 3 groups of patients. The most gender was female and the mean age for 3 groups ranged from 55.1 to 63.7 years. Comparing among 3 groups, it showed a significant difference of calf circumferences between group 1 and group 3. None of pain score differences were statistically significant among 3 groups. In addition, there was no incidence of symptomatic PE in the three groups of the present study. Conclusion: Our findings confirm that acute proximal DVT treatment with ambulation does not increase the incidence of symptomatic PE, compared with absolute bed rest. Although there is no statistical decrease of the severity of pain between those 3 groups, the group of absolute bed rest and compression can promote the resolution of calf swelling, compared with the group of ambulation without compression bandages

Factors influencing prehospital delay time among patients with peripheral arterial occlusive disease

Background: Only one-third of patients with peripheral arterial occlusive disease (PAOD) seek medical care after perceiving the symptoms of PAOD, and most PAOD patients only visit the physician when they develop ulceration and gangrene. Delay can result in lower extremity amputation and death within three years. The aim of this study was to predict prehospital delay time from sociodemographic characteristics and clinical characteristics, social support, knowledge about PAOD, depression and fear, and treatment-seeking behaviors among patients with PAOD. Method and results: Data were collected in three university hospitals in Bangkok, Thailand. A sample of 212 patients with PAOD who were newly diagnosed or diagnosed within the preceding four months was recruited into the study. Questionnaires and interviewing were used to collect data. Stepwise multiple regression analysis was performed to identify the factors influencing prehospital delay time. Significant determinants of prolonged prehospital delay time were male gender, low monthly income (less than 10,000 Thai baht or 213 Euros), high level of perceived social support, and several treatment seeking behaviors. Depression, high level of fear, and self-pay of medical expenses were associated with short prehospital delay time. Overall, the model explained 41.0% of the variance in prehospital delay time. Conclusion: Clinicians need to develop intervention programs and national campaigns to increase knowledge about PAOD among patients in these high risk groups

Factors influencing the presence of peripheral arterial disease among Thai patients with type 2 diabetes

Background: Little is known about factors predicting peripheral arterial disease (PAD) development in Thai type 2 diabetes patients. This study aims to identify factors related to PAD in type 2 diabetes and the best predictors for PAD development. Methods and results: A case-control study was conducted in which 405 type 2 diabetes patients were recruited from four tertiary care hospitals in Bangkok, Thailand. Cases were type 2 diabetes patients with PAD who were compared to those without PAD. An ankle-brachial index (ABI) 70 years, having coronary heart disease as a comorbid illness, and having a body mass index of 25–29.9 kg/m2 were predictive for PAD development (all p < 0.05). These three variables explained 12.3% of the variance in the incidence of PAD among type 2 diabetes patients. The demographic and clinical factors were the best predictors for PAD development. Conclusion: Thai type 2 diabetes patients who are elderly, have coronary heart disease as a comorbid condition, or have a normal weight should be considered at risk for PAD development

The quality and quantity media-cultured mononuclear cell transplantation is safe and effective in ischemic hindlimb mouse model

Objective: This study was conducted to investigate in vitro proangiogenic and anti-inflammatory phenotypes and functions and the in vivo efficacy and safety of quality and quantity (QQ) media-cultured mononuclear cells (MNCs) compared with standard cultured MNCs from the peripheral blood of patients with chronic limb-threatening ischemia (CLTI) with atherosclerotic risk factors. Methods: Peripheral blood MNCs (PBMNCs) from patients with CLTI were cultured in QQ culture media or standard culture media. Phenotypic analysis of progenitor cells (CD34+CD133+), M2 macrophages (CD206+), and inactivated T regulatory cells (CD4+CD25+CD127+), colony-forming assay, and tube formation assay of QQ media-cultured MNCs (QQMNCs) and PBMNCs, were conducted. Intramuscular transplantation of QQMNCs or PBMNCs was performed in the ischemic hindlimb model. The clinical appearance of ischemic limbs was observed, and blood flow in ischemic limbs was measured using a laser Doppler perfusion imager. Outcomes were compared between the QQMNC and PBMNC groups. Results: Twenty patients with CLTI were included. The mean percentages of CD34+ cells, CD133+ cells, CD34+CD133+ progenitor cells, CD206+ cells, colony-forming cells, and tube formation were significantly higher in the QQMNCs. The mean percentage of CD4+CD25+CD127+ cells was significantly lower in QQMNC. The colony-forming unit count and Dil-acetylated low-density lipoprotein uptake were significantly greater in QQMNCs. The clinical appearance of post-QQMNC-injected limbs was less severe than the appearance of post-PBMNC-injected limbs. Limb perfusion was significantly better in the QQMNCs. Conclusions: Proangiogenic and anti-inflammatory phenotypes of MNCs cultured in QQ culture media were reproducible. Intramuscular QQMNC transplantation was safe and resulted in better reperfusion of ischemic hindlimbs compared with PBMNCs. : Clinical Relevance: Intramuscular transplantation of quality and quantity media-cultured mononuclear cells from chronic limb-threatening ischemia patient is safe and effective in the ischemic hindlimb mouse model. The Quality and Quantity media-cultured mononuclear cells might become a novel therapeutic approach in no-option chronic limb-threatening ischemia patients

Navigating Challenges in the Endovascular Treatment of Asymptomatic Aortoiliac Aneurysms: A 10-Year Comparative Analysis

Background: Treating an abdominal aortoiliac aneurysm (AAIA) with endovascular methods can be challenging when the internal iliac artery (IIA) is involved. Embolizing the IIA and extending the limb to the external iliac artery (IIAE + EE) to prevent a type 2 endoleak may lead to pelvic ischemic complications. To avoid these complications, strategies that preserve the IIA, such as the bell-bottom technique (BBT) and the iliac branch device (IBD), have been proposed. This study aims to compare the outcomes of these three endovascular approaches for AAIA. Methods: Between January 2010 and December 2019, 174 patients with asymptomatic AAIA were enrolled in this retrospective analysis. They were divided into two groups: 81 patients underwent non-IIAE procedures, and 93 patients underwent IIAE procedures. The iliac limb study group consisted of 106 limbs treated with the BBT, 113 limbs treated with the IIAE + EE, and 32 limbs treated with the IBD. The primary outcomes included the 30-day mortality rate and intraoperative limb complications. The secondary outcomes included postoperative pelvic ischemia, freedom from reintervention, and the overall 10-year survival rate. Results: There was no significant difference in the perioperative mortality rate between the non-IIAE group (0%) and the IIAE group (2.1%), p = 0.500. The intraoperative limb complications did not differ significantly between the BBT limbs (7.5%), the IIAE + EE limbs (3.5%), and the IBD limbs (3.1%) groups, p = 0.349. The incidence of buttock claudication was significantly greater in the bilateral IIAE + EE group compared to the unilateral IIAE + EE and non-IIAE groups (25%, 11%, and 2.5%, p-value p p = 0.016). There was no significant difference in the overall 10-year survival rate between the non-IIAE and IIAE groups (51.4% vs. 55.9%, p = 0.703). Conclusions: The early and late mortality rates were similar between the non-IIAE and IIAE groups. Preserving the IIA is recommended to avoid pelvic ischemic complications. Considering the higher rate of reintervention in the BBT group, the IBD strategy may be preferred for AAIA