药物涂层球囊血管成形术治疗孤立性腘动脉慢性闭塞的近期效果

【摘要】 目的 评价药物涂层球囊（DCB）血管成形术治疗孤立性腘动脉闭塞性病变的近期临床效果。 方法 回顾性分析2018年1月至2019年6月期间经DCB成形术治疗的孤立性腘动脉慢性闭塞性病变患者临床资料。主要研究终点为靶病变1年初期通畅率,次要研究终点1年二期通畅率、保肢率和临床症状改善等。 结果 共入组31例患者36条患肢（左侧19条）,其中男20例;平均年龄72.7岁。14例患者16条患肢表现为重症肢体缺血（Rutherford分级4～6级）。手术技术成功率为83.3%（30/36）。6例患者靶病变需植入补救性支架,支架辅助技术均获成功。无患者发生远端动脉栓塞和腘动脉损伤,无死亡。平均随访7.8个月,有7例腘动脉再闭塞,其中3例系补救性支架植入患者,补救性支架再闭塞率为3/6。术后1年靶病变初期通畅率、二期通畅率分别为73.2%、83.6%,保肢率为86.1%,截肢/趾均发生于Rutherford分级6级患者。患肢平均踝-肱指数（ABI）由术前0.43上升至术后0.76,所有患者临床症状明显缓解。结论 DCB成形术治疗孤立性腘动脉慢性闭塞性病变安全,近期效果满意。补救性支架似并不能显著提高靶病变通畅率。     

准分子激光消蚀联合药物球囊治疗下肢动脉慢性缺血3例北大核心CSCD

目的分析准分子激光消蚀(ELA)联合药物球囊治疗下肢动脉慢性缺血的安全性和可行性。方法采用ELA联合紫杉醇涂层球囊治疗下肢动脉硬化闭塞症所致下肢动脉慢性缺血患者3例,均为股浅动脉段硬化闭塞病变,其中2例为原发闭塞性病变,1例为支架植入后再闭塞病变。结果 3例患者术后血流恢复通畅,下肢血运明显改善,无手术并发症。术后2周复查缺血症状均无复发,股浅动脉血流通畅,恢复顺利。结论 ELA联合紫杉醇涂层球囊治疗下肢动脉慢性缺血患者原发病变和支架再狭窄病变安全可行,远期随访结果尚需观察更多治疗患者。     

下肢动脉硬化致膝下缺血介入治疗的策略及临床意义

目的 探讨下肢动脉动脉硬化致膝下缺血腔内介入治疗的策略及临床意义.方法 回顾性分析了下肢动脉狭窄闭塞血管内介入治疗患者97例,其中单纯膝下动脉(胫前、胫后动脉)狭窄、闭塞11例,膝上动脉(主髂动脉、股腘动脉)狭窄、闭塞伴有膝下动脉狭窄、闭塞24例.结果 35例患者,成功治疗31例,膝下缺血症状明显改善,取得满意的治疗效果;4例治疗未成功,1例高位截肢,3例足趾截肢.随访3～12个月,股浅动脉再次闭塞2例,胫前或胫后动脉闭塞7例,3例趾尖部干性坏死.结论 血管腔内介入治疗对改善膝下缺血症状疗效显著,有助于提高缺血肢体的救肢率,是治疗下肢缺血性病变安全有效的方法.     

髋关节区动脉支架植入治疗下肢动脉重症缺血的临床效果评价

目的观察与评价髋关节区支架植入治疗下肢动脉重症缺血的安全性、有效性及对股深动脉血流的影响。 方法66例动脉硬化闭塞所致下肢重症缺血患者（共70条动脉,均累及股总动脉和/或股动脉近心段）。平均年龄74.6岁。男46例,女20例。左下肢动脉40条,右下肢动脉30条。开通闭塞动脉后,行球囊扩张及支架植入。 结果术中股动脉急性闭塞3例（局部溶栓后获得通畅）,余下肢动脉即刻血流均获得通畅,下肢缺血症状均明显改善。术后15例患肢出现血流过度灌注,无严重并发症发生。随访54例（失访12例）,随访时间2～30个月,平均（16.2±2.6）个月。25例因再狭窄或闭塞发生患肢缺血,其中16例接受再次介入治疗（PTA及导管溶栓后获二次通畅）。跨髋关节支架均无断裂,股深动脉均仍保持通畅。6例发生心、脑血管意外,其中2例死亡。 结论跨髋关节动脉支架植入可安全、有效地改善下肢动脉重症缺血,且不影响股深动脉血流。     

动脉旁路转流术治疗下肢动脉缺血症

目的 探讨下肢动脉缺血症实施动脉旁路转流术的治疗经验。方法 5例下肢动脉硬化性闭塞引起肢体缺血患者,通过多普勒血流仪检测和动脉造影,确定动脉病变范围。采用PTFE人工血管行动脉旁路转流。结果 肢体获救率100％,术后病人静息痛消失,肢端溃疡愈合,踝肱指数上升。结论 动脉旁路转流术治疗下肢动脉缺血闭塞症是安全有效的,手术成功关键在于重建动脉流入及流出道的通畅。     

微球囊扩张成形术在膝下动脉闭塞性疾病治疗中的初步应用

目的探讨膝下血管微球囊扩张成形术在下肢动脉闭塞性疾病治疗中的应用价值。方法选择以膝下动脉闭塞为主的下肢动脉闭塞性疾病患者32例,共38条肢体,均采用单纯球囊扩张成形术治疗闭塞或严重狭窄病变。结果 38条肢体中技术成功36条(94.73%)。主要并发症有动脉穿孔(1例)、痉挛(1例)及穿刺点血肿(1例)。随访6个月,临床成功率92.11%(35/38)。11例坏疽患者中,1例膝上截肢,救肢率90.91%(10/11)。结论血管微球囊扩张成形术为治疗膝下动脉硬化闭塞症的安全有效的治疗方法,近期疗效满意。     

长球囊在膝下段动脉腔内成形术中的应用

目的 探讨长球囊在膝下段动脉血管成形术治疗中的应用价值.资料与方法 采用长球囊对19例以膝下动脉硬化闭塞性病变为主的Ⅱ型糖尿病患者共21条下肢行血管腔内成形术,同时经保留导管局部灌注抗凝溶栓,扩血管药物治疗.结果 21条患肢中,技术成功18条,成功率85.7%,术后随访3～9个月,52.4% (11/21)下肢发凉、麻木疼痛消失,47.6% (10/21)下肢发凉、麻木疼痛不同程度缓解,1例足部溃疡愈合,1例足部坏死行部分足切除.21条患肢踝臂指数(ABI)由术前0.58±0.13升至术后0.89±0.15及最近一次随访测量值0.85±0.14(P＜0.05).结论 使用长球囊行膝下段动脉血管成形术治疗安全可行,近期疗效确切.     

无流出道显影的下肢动脉闭塞症腔内血管成形治疗的预探索

目的：探讨经皮腔内血管成形术（PTA）治疗无流出道显影的下肢动脉硬化闭塞症（ASO）的临床疗效及价值。方法无流出道显影的下肢ASO患者19例,男11例,女8例,年龄48～79岁,中位年龄66岁。所有患者主要临床症状为患肢静息痛,其中10例（47.6%）伴有不同程度足部溃疡和坏疽。所有患者术前均接受患肢多层螺旋CT血管造影及DSA检查。PTA治疗后随访12个月,观察并记录临床症状和体征变化,于术前和术后1、3、6、12个月分别检测患肢跛行距离、足趾皮温、踝肱指数（ABI）、趾肱指数（TBI）,并作CTA 或彩色多普勒超声检查。结果19例患者共38条病变肢体,54支血管为无流出道显影的下肢动脉闭塞病变,分别为胫前动脉25支（46.3%）、胫后动脉18支（33.3%）、腓动脉9支（16.7%）、腘动脉2支（3.7%）;肢体PTA技术成功率为89.6%,单血管PTA技术成功率为85.2%。术后所有开通成功的患肢皮温改善明显,疼痛症状明显缓解或消失。术后1、3、6、12个月患者跛行距离、足趾皮温、ABI、TBI等均较术前有显著改善（P＜0.05）。术后12个月肢体血管再狭窄率为39.5%（15/38）,肢体血管通畅率为55.3%（21/38）,肢体保全率为81.6%（31/38）。结论 PTA治疗无流出道显影的下肢动脉闭塞病变的近期疗效确切,安全性高;远期再狭窄率虽较高,但能有效控制病情发展并缓解临床症状,有助于提高缺血肢体的保全率。     

双向入路治疗下肢动脉远端流出道闭塞性病变

【摘要】 目的 探讨膝下动脉逆行穿刺建立双向入路治疗下肢动脉远端流出道闭塞性病变的技术特点、安全性和有效性。方法 回顾性分析2018年1月至2019年3月47例患者临床资料,均为顺行入路开通血管失败的腘动脉和远端膝下动脉闭塞,中转采用远端动脉逆行穿刺建立双通路开通血管。结果 技术总成功率为100%（47/47）。无死亡、截肢等严重并发症发生,穿刺并发症发生率为12.8%。术后6、12个月累计通畅率分别为70.5%（31/44）、43.2%（19/44）。结论 在远端血管解剖条件允许下,双向入路治疗下肢动脉远端流出道闭塞性病变能提高血管开通率,并发症发生率低,近期保肢率高。     

长球囊联合丹参注射液加压注射治疗糖尿病膝下血管病变

目的观察长球囊血管腔内成形术(percutaneous transluminal angioplasty,PTA)联合丹参注射液,腔内加压注射治疗糖尿病膝下血管病变的疗效。方法 19例糖尿病患者共23条膝下动脉硬化闭塞肢体,首先采用长球囊开通狭窄、闭塞的血管,再联合丹参注射液腔内加压注射治疗。术后观察踝/肱指数、通畅率、溃疡愈合时间及临床症状的改善。结果 21条患肢得到成功治疗,技术成功率91.3%(21/23)。踝/肱指数(ankle brachial index,ABI)由术前的0.31±0.14上升为术后的0.71±0.18,与术前比较差异有统计学意义(P<0.05)。术后随访3～10个月,13条患肢(61.9%)间歇性跛行、患肢静息痛等临床症状基本消失,足背或胫后动脉搏动恢复;8条(38.1%)患肢明显缓解。6条肢体术前伴足趾溃疡者,术后创面均愈合;1条足趾坏疽肢体清创换药23天后行截趾术,术后切口愈合良好。术后1、3、6个月通畅率分别为95.2%、85.7%、61.9%。结论腔内加压注射丹参注射液作为长球囊PTA微创治疗糖尿病合并膝下血管病变的补充,可促进动脉侧支血管生成,改善血供,改善微循环,促进糖尿病足溃疡面愈合,近期疗效好、通畅率高,值得推广。     

Infrainguinal directional atherectomy: Long-term follow-up and comparison with percutaneous transluminal angioplasty

Purpose To assess the long-term results of directional atherectomy (DA) for femoropopliteal artery atherosclerotic lesions and to compare the results to those previously reported for percutaneous transluminal balloon angioplasty (PTA).Materials and Methods Eighty-four percutaneous DA procedures performed on 75 patients between July 1988 and August 1992 were retrospectively reviewed and evaluated for technical and initial clinical success. Long-term patency was assessed with a combination of ankle-brachial index measurements and angiography.Results Initial technical success was achieved in 77 of 84 procedures (92%). Follow-up of 72 patients was obtained, including 74 of the 84 (88%) DA procedures with a mean follow-up of 17.4 months (range 1–48 months). Primary patency was 78% at 1 year and 57% at 2 years. Patients with diabetes, complete luminal occlusion, or limb salvage situations had significantly lower patency.Conclusions Femoropopliteal artery DA can be performed safely with a high technical and initial clinical success. Long-term patency is improved when compared with published series for PTA. With this improvement in mind, DA may have a place in the treatment of focal infrainguinal stenoses.     

Arterial occlusive disease below the knee: treatment with percutaneous transluminal angioplasty performed with low-profile catheters and steerable guide wires

In 98 patients with arterial occlusive disease below the knee who were candidates for limb salvage surgery, percutaneous transluminal angioplasty (PTA) was performed with a low-profile balloon catheter and steerable guide wire system. Sixteen patients had bilateral disease; thus, there were 114 endangered limbs and 145 diseased vessels, including 19 with a single stenosis, 94 with multiple stenoses, and 32 with total occlusions. Primary anatomic success was achieved in all stenosed vessels and in 28 occluded vessels. Initial limb healing without amputation was achieved in 88% of limbs. In four patients occluded vessels could not be recanalized; thus, the four affected limbs were amputated. Two years after PTA, 32 of 37 patients available for follow-up had viable pain-free extremities. Cumulative limb salvage rate at 2 years was 86%. At this time, below-the-knee PTA is still recommended only for limb salvage candidates. However, with this new catheter and guide wire system, success rates have been increased and complication rates decreased. PTA may be useful in selected patients with severe claudication.     

Infra-inguinal percutaneous transluminal angioplasty for limb salvage: a retrospective analysis in a single center

PURPOSE: To review the feasibility of infra-inguinal angioplasty in the management of critical limb ischemia (CLI). MATERIAL AND METHODS: Data on 221 patients with 230 critically ischemic limbs, treated with consecutive percutaneous transluminal angioplasty (PTA) at Helsinki University Central Hospital between January 2000 and December 2002 were collected and analyzed retrospectively. Patency, limb salvage, and survival rates were calculated on an intention-to-treat basis. Comparisons were done with univariate (Kaplan-Meier) and multivariate analysis (Cox regression). RESULTS: Overall primary patency, secondary patency, limb salvage, and survival rates were 47%, 59%, 92%, and 76%, respectively, at 12 months. In the multivariate analysis, low toe pressure (< or =30 mmHg) was a significant risk factor for poor patency. Uremia with hemodialysis, low toe pressure (< or =30 mmHg), and hemodynamic failure of the endovascular procedure were found to increase significantly the risk of amputation. Uremia with hemodialysis, coronary artery disease, tissue loss as indication for PTA (Fontaine stage IV), and age over 70 years were all found to increase significantly the risk of death. CONCLUSION: Infra-inguinal PTA is feasible in patients with CLI and resulted in good limb salvage.     

Infrapopliteal percutaneous transluminal angioplasty for limb salvage

Purpose:
To evaluate long-term results of infrapopliteal percutaneous transluminal angioplasty (PTA) for limb salvage.
Material and Methods:
A retrospective study of 71 consecutive infrapopliteal PTAs in 49 patients with rest pain (n=20) or ulceration (n=29) was conducted. In 18 patients, surgical minor amputation or debridment was also performed.
Results:
Technical success was achieved in 45 patients. Four failures necessitated 2 amputations. One patient died in the postoperative course. Global morbidity rate was 16%, including minor complications in 5 patients and major vascular complications in 3 patients. After technical success during the follow-up (median duration 21 months), restenoses occurred in 4 patients, of whom 3 had a successfull re-PTA (clinical success rate 72%). Survival, primary patency, secondary patency and limb salvage rates were, respectively, 75%, 81%, 88% and 87% after 3 years. The only positive predictive factor for primary patency was the presence of diabetes mellitus.
Conclusion:
Infrapopliteal PTA is a safe and effective procedure, allowing good patency and limb salvage rates with low mortality and morbidity.     

Percutaneous transluminal angioplasty of infrapopliteal vessels: preliminary results and technical considerations

Infrapopliteal balloon angioplasty was performed in 11 patients facing reconstructive surgery for limb salvage. Twelve separate sessions of angioplasty were performed, during which 15 of 16 diseased tibial runoff vessels were successfully dilated. Three complications occurred during percutaneous transluminal angioplasty (PTA). One was related to the concomitant use of a thrombolytic agent to open a femoropopliteal bypass graft and not related to the angioplasty itself. No limbs were lost as a result of complications. The procedure was a technical success in nine of 12 cases (75%) and an initial clinical success in eight of the nine that were technically successful (89%). Follow-up ranged from 1 to 22 months. Six of the nine cases (67%) remained clinically successful during this period. Preliminary results suggest that infrapopliteal PTA is a safe and effective alternative to surgical reconstruction in selected patients.     

Cutting balloon percutaneous transluminal angioplasty for salvage of lower limb arterial bypass grafts: feasibility

PURPOSE: To evaluate the feasibility of cutting balloon percutaneous transluminal angioplasty (PTA) for treatment of neointimal hyperplasia in peripheral arterial bypass grafts. MATERIALS AND METHODS: Fifteen consecutive patients (six women, nine men; age range, 57-89 years; mean age, 71 years) were treated with cutting balloon PTA for 16 anastomotic stenoses after infrainguinal bypass (prosthetic grafts, seven patients; prosthetic-vein composite grafts, two; venous grafts, five; and ileofemoral stent-graft, one). Cutting balloon PTA was followed by conventional PTA to improve anastomotic diameter. Patients with stenotic vein grafts underwent cutting balloon PTA after failed conventional PTA; the other patients were treated primarily with cutting balloon PTA. Criteria for success were a lumen diameter improvement of greater than 50% or residual stenosis of 20% or less. Follow-up was performed with color duplex ultrasonographic surveillance. Patency rates and durations were calculated with Kaplan-Meier survival curves and log-rank statistics. RESULTS: Attempted conventional PTA (n = 6) prior to cutting balloon PTA was unsuccessful. Cutting balloon PTA was technically successful in 15 (94%) of 16 lesions, without clinical complications. Two local restenoses and one graft occlusion occurred between 5 and 7 months. The cumulative 6-month primary and secondary graft patency rates were 84% and 92%, respectively. At 12 and 18 months, they were 67% (95% CI: 0.34, 0.86) and 83% (95% CI: 0.48, 0.96), respectively; mean follow-up was 10.0 months. CONCLUSION: Cutting balloon PTA proved feasible for treatment of resistant peripheral arterial bypass graft stenosis, commonly caused by neointimal hyperplasia, with excellent technical success. Short-term patency with this technique appears to be superior to that with conventional PTA, and it compares well with patency of atherectomy for salvage of infrainguinal bypass grafts.     

Femoral, popliteal, and tibial arteries: percutaneous transluminal angioplasty

We attempted percutaneous transluminal angioplasty in 70 patients with obliterative atherosclerosis of the femoral, popliteal, and tibial arteries. Patients with limb threatening ischemia (rest pain, nonhealing ulcer, or gangrene) or lifestyle-limiting claudication were acceptable candidates. Stenoses less than 4 cm long or occlusions less than 10 cm long and less than 2 years old were considered favorable for angioplasty, but less desirable lesions were accepted for limb salvage. Patients with increased surgical risk, inadequate saphenous veins, poor runoff, or in whom temporizing was necessary or desirable, were offered angioplasty for revascularization as an alternative to surgical reconstruction. Technical success was achieved in 62 (88%) of 70 patients with five early failures for an overall initial success rate of 57 (81%) of 70. Complete relief of clinical symptoms was achieved in 53 patients (92%) and 54 had improved lower limb perfusion when measured noninvasively. Patency rate at 1 year was 89% +/- 5% and in 2 years 84% +/- 6% by life table analysis. Major complications occurred in eight (11.4%) of 70 procedures. We conclude that angioplasty of femoral, popliteal, and tibial vessels is an effective and safe alternative to traditional surgical bypass grafting for revascularization of the ischemic lower extremity. Early patency rates are comparable to saphenous vein grafts and considerably better than prosthetic reconstruction.     

Prospective trial of infrapopliteal artery balloon angioplasty for critical limb ischemia: angiographic and clinical results

PURPOSE: To evaluate the safety and efficacy of infrapopliteal percutaneous transluminal angioplasty (PTA) as a primary treatment of chronic critical limb ischemia in a prospective trial. MATERIALS AND METHODS: Infrapopliteal PTA was performed on 72 limbs of 60 patients (mean age, 72 y; range, 38-92 y) and patients were followed for 12-24 months. RESULTS: The primary angiographic success rate for the stenoses was 84% (102 of 121) and that for the occlusions was 61% (41 of 67) with corresponding restenosis rates of 32% and 52% at follow-up angiography performed a mean of 10 months after primary PTA. The rate of major complications was 2.8% (access site pseudoaneurysms in two patients). The primary clinical success was 63% (45 of 72). A 48% cumulative primary patency rate, a 56% secondary patency rate, and a 80% cumulative limb salvage rate were registered at 18 months, as determined with use of Kaplan-Meier analysis. Lack of angiographic improvement at the site of the most severe ischemia and renal insufficiency (serum creatinine level > 130 micromol/L) were independent predictors of poorer long-term clinical results, as determined with use of Cox multiple regression analysis. CONCLUSIONS: Infrapopliteal PTA is a feasible primary treatment of chronic critical limb ischemia with moderate primary angiographic and clinical success, a low complication rate, and a cumulative limb salvage rate comparable with surgical techniques.     

经皮腔内血管成形术治疗膝下动脉硬化闭塞症的临床分析

目的探讨经皮腔内血管成形术（percutaneous transluminal angioplasty,PTA）对膝下动脉硬化闭塞症的治疗效果。方法回顾性分析我院从2006年10月-2009年2月采用PTA治疗膝下动脉硬化闭塞症的32例患者（42条肢体）的病史资料和术后随访资料。结果39条肢体获得影像学成功（残余狭窄率〈30％）,技术成功率为92．9％（39／42）,治疗后第1周踝／肱指数（ABI）由术前的0．44＋0．12增至0．82＋0．20,术后6、12个月肢体通畅率分别为为85．7％（36／42）和71．4％（30／42）,术后12个月肢体保全率和存活率分别为92．9％（39／42）和93．8％（30／32）。结论PTA治疗膝下动脉硬化闭塞症的临床成功率高、并发症少、救肢率高,是安全有效的治疗膝下动脉硬化闭塞症的方法。     

Reteplase in the treatment of thrombosed hemodialysis grafts.

PURPOSE: To prospectively evaluate the efficacy and safety of reteplase with percutaneous transluminal angioplasty (PTA) in the treatment of thrombosed polytetrafluoroethylene hemodialysis arteriovenous grafts (AVGs). MATERIALS AND METHODS: Forty-two patients were entered into the study. Sixty-two procedures in 43 grafts were performed. One unit of reteplase and 4,000 units of heparin were administered into the AVGs. Routine venography and percutaneous transluminal angioplasty (PTA) was then performed. Patients were transferred for hemodialysis immediately after the procedure. RESULTS: Technical success was achieved in 92% of the cases. Four cases involved intentional repeat thrombosis because of poor outflow and/or need for a new graft site. Minor complications occurred in 6.5% of the cases. No major complications occurred. The mean procedure time for experienced versus less-experienced interventionalists was significantly shorter (P <.001). Primary patency rates were 50%, 34%, and 34% at 30, 90, and 180 days, respectively. CONCLUSION: Reteplase in conjunction with heparin and PTA is a safe and effective means of thrombolysis of AVGs. Its efficacy is comparable to that of other available thrombolytic drugs.