The Preliminary Clinical Study Of Morphologic Categorization For Lower Limb Atherosclerosis Obliterans In Chinese Patients

Objectives:Collected angiography and other imaging data of patients who suffer from lower extremity arterial occlusive disease were reviewed retrospectively, to provide a preliminary classification criteria for Chinese patients with lower extremity arterial occlusive disease according to the lesion Characteristic, cumulative area, length, the inflow, outflow conditions and feature of the endovascular treatment, et al. To guide clinical treatment by this categorization, and to find an endovascular therapeutic regimen for Chinese patients with lower extremity arterial occlusive disease.Materials and methods:442 limbs in 307 patients (200 males and 107 females), mean aged 70.7±12.7 (ranged 26-95), who were diagnosed lower extremity occlusive disease were collected between January 1999 and May 2010. Angiography and other imaging data of these patients were reviewed retrospectively to classify them into type I to type V group according to the lesion Characteristic, cumulative area, length, the inflow, outflow conditions and feature of the endovascular treatment, et al. Contents of the 5 types are as follows, Type I:single/multiple stenosis in iliac/femoral/popliteal arteries, normal/stenosis BTKA, type I is further divided inⅠa (no stenosis or occlusions in below the knee arteries, BTKA) and Ib (single/multiple stenosis lesions in BTKA); TypeⅡ: single/multiple stenosis in iliac/femoral/popliteal arteries, occlusions occur in BTKA, type II is further divided in Ha (normal inflow tract, occlusive midpiece and normal/stenosis/occlusive outflow tract in BTKA) andⅡb (occlusive inflow tract, occlusive midpiece and normal/stenosis/occlusive outflow tract in BTKA); Type III:single occlusions in iliac/femoral/popliteal arteries with normal/stenosis BTKA; Type IV:single occlusion in iliac/femoral/popliteal arteries, occlusions occur in BTKA, type IV is further divided in IVa (normal/stenosis inflow tract, occlusive midpiece and normal/stenosis/occlusive outflow tract in BTKA) and IVb(occlusive inflow tract, occlusive midpiece and normal/stenosis/occlusive outflow tract in BTKA); TypeⅤ:occlusion of all superficial femoral arteries (SFA), popliteal arteries and BTKA. To statistically analyze and summarize the characteristics of Chinese patients with lower extremity arterial occlusive disease according to this categorization criterion.Results:1617 lesions were detected in 442 limbs of 307 patients (60% occlusions). Stenosis was defined by a reduction of lumen diameter between 50 and 99%. Occlusion was defined by a total obliteration of the lumen. In case of a segment with multiple stenoses or short occlusions, the length refers to each individual lesion and not to the length of the entire affected segment. but in multiple lesions, if normal vessel length was less than 5cm between the two stenosis/occlusions, they are regarded as one lesion.470 (72.6%) mid-short lesions(＜10cm) and 177 (27.4%) long lesions (>10cm) were detected among stenosis lesions.167 (17.2%) mid-short lesions (<10cm) and 803 (82.8%) long lesions (>10cm) were detected among occlusive lesions.127(7.9%) lesions occurred in iliac arteries 354 lesions (21.9%) in femoral arteries,191(11.8%) lesions in popliteal arteries and 945(58.4%) lesions occurred in BTKA.72.2% lesions occurred in BTKA were occluded, most of which were longer than 10cm (P<0.001). Chinese patients were morphologically classified into type I to type V groups. The severity and accumulative area were severer from type I to type V in this study. There were 32 (7.3%) type I limbs. Among these 25 (5.7%) were type la and 7 (1.6%) were type Ib; 177 (40.2%) were typeⅡlimbs, and among these 95 (21.5%) were typeⅡa,82 (18.7%) were typeⅡb; 47 (10.6%) were typeⅢ; 175 (39.6%) were type IV, among these 72 (16.3%) were type IVa and 103 (23.3%) were typeⅣb; 11 (2.3%) limbs were typeⅤ.Conclusions:①Chinese patients with lower extremity arterial occlusive disease were mainly occlusive disease, stenosis were mainly short lesions, occlusions were mainly long ones and diffused distributed, lesions of Chinese patients with lower extremity arterial occlusive disease mainly occurred in BTKA and least in the iliac arteries;②The morphologic typeⅡ(40.2%) was the most common in this study, then the typeⅣ(39.6%),all types were listed of more to less quantity as follows (including subtypes):Ⅳb,Ⅱa,Ⅱb,Ⅳa,Ⅲ,Ⅰa,ⅤandⅠb;③The morphologic categorization of Chinese patients with lower extremity arterial occlusive disease according to lesion characteristic and feature of endovascular treatment is consistent with the literatures about endovascular treatment published before;④The morphologic categorization of Chinese patients with lower extremity arterial occlusive disease proposed in this study can provide a new guidance of choosing feasible endovascular treatment measures.