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Objective To explore the relationship between type 2 diabetes with diabetic peripheral neuropathy (DPN),diabetes nephropathy, and lower extremity atherosclerosis. Methods A total of 298 T2DM patients admitted to the Department of Endocrinology of our hospital from January to December 2020 were selected and divided into the DPN group (178 cases) and the non-DPN group (120 cases) according to whether combined with DPN. The levels of random urinary albumin/creatinine ratio (UACR),fasting blood sugar (FBS), 2-hour postprandial C-petide (2 h CP) and the incidence of lower limb atherosclerosis and diabetic nephropathy were compared between the two groups, and the independent risk factors of DPN were analyzed. Results There were statistically significant differences in age, gender, course of disease and random UACR,FBS and 2 h CP levels between the two groups (P＜0.05),while there were no statistically significant differences in other indicators (P＞0.05) .The incidence of lower extremity atherosclerosis and diabetic nephropathy between two groups was statistically significant (P＜0.05) .Lower extremity atherosclerosis and diabetic nephropathy were independent risk factors for DPN (P＜0.05) .Conclusion DPN is significantly correlated with diabetes nephropathy and lower limb atherosclerosis. [ABSTRACT FROM AUTHOR]

Abstract Background Bilirubin has been found to protect against overt atherosclerotic diseases, but to date, few studies have investigated the effects of bilirubin especially within the normal range on lower limb atherosclerosis. Therefore, we aimed to assess the associations of bilirubin within normal limits including total bilirubin (TB), conjugated bilirubin (CB) and unconjugated bilirubin (UCB) with lower limb atherosclerosis in Chinese patients with type 2 diabetes mellitus (T2DM). Methods 7284 T2DM patients with normal levels of serum bilirubin were included in this cross-sectional, real-world study. Patients were divided into quintiles by TB levels ( 13.99 µmol/L). Lower limb ultrasonography was conducted to detect lower limb plaque and stenosis. The association between serum bilirubin and lower limb atherosclerosis was explored by multiple logistic regression. Results A remarkable decrease in the prevalence of lower limb plaque (77.5, 75.3, 70.7, 71.7 and 67.9%) and stenosis (21.1, 17.2, 13.3, 13.0 and 12.0%) was observed across the TB quintiles. Multivariable regression analysis showed that serum TB levels were negatively correlated with higher risks of lower limb plaque and stenosis, both as a continuous variable [OR (95%CI): 0.870 (0.784–0.964), p = 0.008 for plaque; and 0.835 (0.737–0.946), p = 0.005 for stenosis] and as categorized in quintiles (p = 0.015 and 0.016 for plaque and stenosis). Interestingly, serum CB levels were only negatively correlated with lower limb stenosis [OR (95%CI): 0.767 (0.685–0.858), p

Background: Bilirubin has been found to protect against overt atherosclerotic diseases, but to date, few studies have investigated the effects of bilirubin especially within the normal range on lower limb atherosclerosis. Therefore, we aimed to assess the associations of bilirubin within normal limits including total bilirubin (TB), conjugated bilirubin (CB) and unconjugated bilirubin (UCB) with lower limb atherosclerosis in Chinese patients with type 2 diabetes mellitus (T2DM). Methods: 7284 T2DM patients with normal levels of serum bilirubin were included in this cross-sectional, real-world study. Patients were divided into quintiles by TB levels (< 8.7, 8.7-10.19, 10.20-11.99, 12-13.99, > 13.99 µmol/L). Lower limb ultrasonography was conducted to detect lower limb plaque and stenosis. The association between serum bilirubin and lower limb atherosclerosis was explored by multiple logistic regression. Results: A remarkable decrease in the prevalence of lower limb plaque (77.5, 75.3, 70.7, 71.7 and 67.9%) and stenosis (21.1, 17.2, 13.3, 13.0 and 12.0%) was observed across the TB quintiles. Multivariable regression analysis showed that serum TB levels were negatively correlated with higher risks of lower limb plaque and stenosis, both as a continuous variable [OR (95%CI): 0.870 (0.784–0.964), p = 0.008 for plaque; and 0.835 (0.737–0.946), p = 0.005 for stenosis] and as categorized in quintiles (p = 0.015 and 0.016 for plaque and stenosis). Interestingly, serum CB levels were only negatively correlated with lower limb stenosis [OR (95%CI): 0.767 (0.685–0.858), p < 0.001], whereas serum UCB levels were only negatively associated with lower limb plaque [ OR (95%CI): 0.864 (0.784–0.952), p = 0.003] after a fully-adjusted analysis. Furthermore, serum CRP was significantly decreased across the TB quintiles and negatively associated with serum TB (r = -0.107, p < 0.001), CB (r = -0.054, p < 0.001), and UCB (r = -0.103, p < 0.001). Conclusions: High-normal serum bilirubin levels were independently and significantly related to reduced risks of lower limb atherosclerosis in T2DM patients. Furthermore, serum bilirubin levels including TB, CB and UCB were inversely correlated with CRP. These results suggested that higher-normal serum bilirubin may exhibit an anti-inflammatory and protective effect against lower limb atherosclerotic progression in T2DM subjects. [ABSTRACT FROM AUTHOR]

The article discusses different views on distal embolism in endovascular revascularization of lower limb arteries. Attention is drawn to the con­tribution of the drug coating of the balloon catheter to the development of distal embolization.

We performed a comprehensive evaluation of the hemostatic system and markers of endothelial dysfunction in patients with obliterating lower limb atherosclerosis involving the femoral-popliteal-tibial segment. Progressive course of obliterating atherosclerosis is associated with hypercoagulation (increased platelet aggregation activity, shortened aPTT, PT, TT, increased levels of fibrinogen, SFMCs, and D-dimer), as well as with endothelial dysfunction (increased levels of endothelin-1, von Willebrand factor, homocysteine, and Creactive protein).

Objective: To compare the short-term and long-term outcomes of hybrid interventions after various infrainguinal reconstructions (restoration of blood flow through superficial femoral artery and pulsatile blood flow through deep femoral artery) in patients with iliac-femoral arterial disease., Material and Methods: A retrospective analysis included patients after hybrid iliac-femoral interventions between 2014 and 2018. These interventions included stenting of iliac arteries and various open infrainguinal reconstructions. The first group ( n =41) consisted of patients who underwent reconstruction of superficial femoral artery, the second group ( n =88) - restoration of pulsatile blood flow in deep femoral artery. We analyzed the Rutherford score, perioperative complications, primary patency rates and limb salvage rates after 12 months in both groups., Results: Significant improvement (Rutherford score +3) was achieved in 28 (70%) and 14 (15.9%) patients, respectively ( p <0.05). There were no significant between-group differences in the number of postoperative complications. Surgery time was longer in the first group (median 160 and 130 min, respectively, p <0.05). However, intraoperative blood loss was similar. Primary patency rates after 12 months were 82.4% and 95.1%, respectively ( p =0.054). Limb salvage rates after 12 months were 94.7% and 100%, respectively ( p <0.05)., Conclusion: This study highlights the potential advantages of restoring pulsatile blood flow through the deep femoral artery in hybrid interventions. Higher primary patency and limb salvage rates in the second group indicate better long-term outcomes after restoration of blood flow through the deep femoral artery. Further prospective studies are needed to confirm these results and determine the underlying mechanisms of differences.

Objective To observe the G-395A polymorphisms of Klotho gene in type 2 diabetes mellitus ( T2DM) pa-tients, and to investigate its influence on combined lower limb atherosclerosis. Methods The G-395A polymorphisms of Klotho gene from 205 cases of normal controls (85 cases of Han nationality, 120 cases of Yi nationality, control group), 140 cases of T2DM patients (79 cases of Han nationality, 61 cases of Yi nationality, T2DM group) and 224 cases of patients with lower limb atherosclerosis combined with T2DM (157 cases of Han nationality, 67 cases of Yi nationality, atherosclerosis group) were detected by real-time fluorescence quantification PCR ( FQ-PCR) .The genotype frequency and allele frequency were compared between each group, and the risk factors of T2DM combined with lower limb atherosclerosis were analyzed. Results The genotype frequency of Klotho gene G-395A site G/A+A/A in the atherosclerosis group of Han nationality was higher than that of Yi nationality (P<0.05).There was no significant difference in genotype and allele frequency among the rest groups (all P>0.05).The influence factors of T2DM patients with lower extremity atherosclerosis in Han nationality were systolic blood pressure, TG, LHL, fasting blood-glucose ( FPG) and genotype of Klotho gene G-395A site G/A+A/A (all P<0.05).The influence factors of T2DM patients with lower extremity atherosclerosis in Yi nationality were TG, LHL, FPG and serum creatinine (all P<0.05).Conclusions There is gene polymorphism at G-395A of Klotho gene in T2DM patients with lower limb atherosclerosis. The Klotho gene G-395A site G/A+A/A genotype may be a genetic risk factor for the occurrence of lower limb atherosclerosis of T2DM patients in Han nationality. [ABSTRACT FROM AUTHOR]

Background: Both carotid and lower limb atherosclerosis are associated with increased cardiovascular and cerebrovascular risks. However, it is still unclear whether the concomitant presence of carotid and lower extremity atherosclerosis further increases the cardiovascular and cerebrovascular risks. Therefore, our aim is to investigate whether the coexistence of carotid and lower extremity atherosclerosis was associated with higher cardiovascular and cerebrovascular risks in patients with type 2 diabetes. Methods: This cross-sectional study was performed in 2830 hospitalized patients with type 2 diabetes. Based on carotid and lower limb Doppler ultrasound results, the patients were divided into three groups including 711 subjects without atherosclerosis, 999 subjects with either carotid or lower limb atherosclerosis, and 1120 subjects with both carotid and lower limb atherosclerosis. And we compared the clinical characteristics and prevalence of both cardio-cerebrovascular events (CCBVEs) and self-reported cardio- cerebrovascular diseases (CCBVDs) among the three groups. Results: After adjusting for age, sex, and duration of diabetes, there were significant increases in the prevalence of both CCBVEs (3.8 vs. 11.8 vs. 26.4 %, p < 0.001 for trend) and self-reported CCBVDs (6.9 vs. 19.9 vs. 36.5 %, p < 0.001 for trend) across the three groups (diabetics without atherosclerosis, diabetics with either carotid or lower limb atherosclerosis, and diabetics with both carotid and lower extremity atherosclerosis). A fully adjusted logistic regression analysis also revealed that compared with those without atherosclerosis, those with either carotid or lower limb atherosclerosis had higher risk of CCBVEs (OR 1.724, 95 % CI 1.001-2.966) and self-reported CCBVDs (OR 1.705, 95 % CI 1.115-2.605), and those with concomitant presence of carotid and lower extremity atherosclerosis had the highest risk of CCBVEs (OR 2.869, 95 % CI 1.660-4.960) and self-reported CCBVDs (2.147, 95 % CI 1.388-3.320)(p < 0.001 for trend in CCBVEs and p = 0.002 for trend in CCBVDs, respectively). Conclusions: Either carotid or lower limb atherosclerosis was obviously related to increased cardio-cerebrovascular risk in type 2 diabetes. The concomitant presence of carotid and lower extremity atherosclerosis further increased cardio-cerebrovascular risk in patients with type 2 diabetes. The combined application of carotid and lower extremity ultrasonography may help identify type 2 diabetics with higher cardio-cerebrovascular risk. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study is to assess the relationship between body mass index (BMI) and long-term clinical outcomes in retrograde endovascular recanalization (ER) regarding chronic total occlusions (CTOs) of the infra-inguinal lower limb arteries., Methods: The study included patients who underwent retrograde ER of CTOs localized in superficial, popliteal or below-the-knee arteries. During follow-up, major adverse cardiac and cerebrovascular and major adverse lower limb events (MALE) were evaluated. MALE was defined as amputation, target lesion re-intervention, target vessel re-intervention and surgical treatment., Results: The study included 405 patients at the mean age of 67.2 ± 10.4. The authors divided the overall group of patients according to BMI into < 25 (n = 156, 38.5%) and ≥ 25 kg/m2 (n = 249, 61.5%), and then into < 30 (n = 302, 75.8%) and ≥ 30 kg/m2 (n = 103, 24.2%). During the average follow-up 1,144.9 ± 664.3 days, the mortality rate was higher in the group of patients with BMI < 25 kg/m2 (10.5% vs. 5.3%, p = 0.051), and in the group of patients with BMI < 30 kg/m2 (8.7% vs. 2.9%, p = 0.048). The comparison of Kaplan-Meier curves revealed borderline differences when assessing months to death for the BMI < 25 kg/m2 (p = 0.057) and BMI < 30 kg/m2 (p = 0.056) grouping variables., Conclusions: Obese and overweight patients undergoing CTO ER of the lower limb arteries from retrograde access are related to lower death rates during long-term follow-up.