| Lower limb ischemic disease is a type of severe vascular disease,and it is a common and multiple disease in arterial system disease,lower limbs of ASO, thromboangiitis obliterans and arterial thrombosis more common. Pathology showed that the main artery is stenosis or occlusion,therefore,insufficiency blood of distal artery well caused rest pain,intermittent claudication,ischemic ulcers,tissue necrosis and other acute or chronic clinical symptoms of ischemic hypoxia,collateral artery can formate around the pathologic vascular . The degree of limb ischemia and hypoxia depends on the speed of arterial lesions, pathologic changes and the formation of collateral circulation status and quantity. pathologic main artery of the inflow aisle,distal outflow aisle,the formation status of collateral arterial,conditions of distal blood aisle,are very important for reasonable choice before surgery,guide of clinical treatment and evaluation of treatment effect . At the same time. As collateral arteries often form around the stenosis or occlusion of arteries and the number of collateral formation have certain relationship with the location,extent and pathologic time of the stenosis or occlusional segments. Therefore,Early,accurate and effective imagings of lower extremity arterial ischemic diseases are particularly important for diagnosis and treatment. Dates showed that varieies of imaging methods,such as DSA,CTA,MRA and so on,have advantages and disadvantages on diagnosis of lower limb ischemic disease and assessment of collateral arteries around the pathologic arteries. At present,Color Doppler Ultrasound has become the first choice of clinical examination of the lower limb ischemic disease for its simple,real-time and accurate and so on. However,it is still reported rarely on examination the establishment situation of the collateral arteries around pathologic arteries on Color Doppler Ultrasound and the deeply research of the collateral arteries.Objective:According to detected results of ischemic lower limb lesions of arteries and collateral arteries by color Doppler flow imaging and spectral Doppler ultrasound, Investigating the relevance between different diseases, course and clinical stages of disease arteries with collateral artery formation characteristics; and Investigating the correlation between distal different lesions of artery with collateral artery resistance index. Methods:This study selected 116 patients with lower extremity ischemia with color Doppler ultrasonography:1. observating and measuring arterial wall and lumen situation by Two-dimensional ultrasound images using real-time.2.Observating the blood flow conditions of lesion main arteries and the collateral arteries by color Doppler flow imaging and.3. Observating the frequency spectrum of blood flow patterns and calculating quantitatively the peak velocity of blood flow.4.Particularly observating the locationg and number of collateral artery, and the resistance index and peak velocity.Results:1.The number of collateral arteries formated around in thigh and calf lesions of artery of sclerosing ASO patients show many more significant differences (P <0.05) than diabetic ASO patients; The number of collateral arteries formated around in thigh lesions of artery of sclerosing ASO patients show many more significant differences (P <0.05) than thromboangitis obliterans; The number of collateral arteries formated around in calf lesions of artery of diabetic ASO patients show less significant differences (P <0.05) than thromboangitis obliterans.2.The number of collateral arteries formated in the patient groups of 10 days to 3 years, 3 years to 10 years and 10 years to 15 years increased with increasing duration, the differences are significant (P <0.05); The number of collateral arteries formated in the patient groups of 10 years to 15 years, 15 years to 20 and over 20 years patient group decreased with increasing duration, the differences are significant (P <0.05). Therefore, the number of collateral artery is closely related to the lesions of time of arterial ischemia and hypoxia.3.In 116 patients, the number of collateral arteries formated patient group of clinical phase 1 is more than clinical phase 2 and clinical phase 3, the difference are significant (P <0.05); the number of collateral arteries formated patient group of clinical phase 2 is more than clinical phase 3, the difference are significant (P <0.05).4.The resistance index of collateral arteries which formated around distal arteries of moderate severe stenosis or occlusion are higher than distal arteries of not narrow or mild stenosis, the difference was significant ( P <0.05), while the flow rate are lower, the difference are also significant ( P <0.05).Conclusions:1. Detecting the collateral artery by Color Doppler flow imaging has its advantage Color Doppler flow imaging can detecte the blood flow signals of collateral arterial sensitively and judge the shape and direction of collateral arteries, which are helpful to understand the establishment of body's collateral arterial network after arteries diseases and may initially judge the lesion and the blood supply of distal lumen collateral arteries.Therefore, color Doppler flow imaging has a special diagnostic significance for displaying collateral arteries formatted around ischemic arteris.2.The establishment characteristics of collateral arteries in the lower limb ischemic disease(1) The collateral arteries distribute in different parts in different diseases of the lower limb ischemic diseaseSclerosing ASO artery disease may involve all parts of the lower limbs, lower limbs can have rich collateral arteries formatted and may be have not obvious symptoms of ischemia and hypoxia in longer period of time.Diabetic ASO more performance symptoms of chronic ischemia and hypoxia on leg and foot, but the mumber of collateral arteries established on leg lesions section is usually few, so diabetic ASO patients with a long course of disease often leads to gangrene of ischemic diabetic foot in later period.The lesions of thromboangitis obliterans patients usually involve the distal artery, the munber of collateral arteries established in the distal arterial segment of leg are often rich, which can improve the blood supply of the lower leg and foot, so, the symptoms are usually not obvious.(2) The formation status of collateral arteries are related to the duration of lower limb ischemia diseaseIn theory, There are often do not have collateral arteries or few collateral arteries established when arteries happen acute ischemic; while, many of collateral arteries which formated around lesions arterial will improve the ischemic and hypoxia stasus of artery lesions arterial when arteries are chronic ischemia.ASO is a kind of chronic disease, the collateral arteries are usually rich; lesions often happen early in TAO and usually involve the distal artery of lesions, the collateral arteries often established distal arterial of the calf.However, the collateral arteries can be further involved with the increasing of disease duration , atherosclerosis and stenosis, these will result in stenosis and occlusion of collateral artery, and reduce the number of collateral, then ischemic symptoms will more serious.(3) The clinical manifestations of lower limb ischemia are related with the formation status of collateral arteries to some extentSome thick collateral arteries will open because of the change of shear stress and relief acute limb ischemia temporarily when arterial are acute ischemia; when the events of chronic arterial ischemia are happen, collateral arteries have sufficient time to formate collateral cycle, early symptoms of disease can not be obvious; ischemia and hypoxia symptoms will appear when the collateral arteries reaches the critical state and further decompensate.3. The flow velocity and resistance index of Collateral artery are the indirect indicators which reflects the resistance blood perfusion of distal arterialWhen the occlusion of distal arterial are severe, due to large artery resistance, the resistance index of collateral arteries are higher, but the systolic peak velocity are lower,which show high resistance and low frequency spectrum.When the occlusion of distal arterial are not narrow and mild stenosis, the resistance of collateries into the distal arteries are lower, but the velocity are faster, ,which show a low resistance and high frequency spectrum.Therefore, the spectrum of collateral arteries can reflect flexibility and perfusion of l the distal arterial. |
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