Silverhawk斑块旋切系统治疗下肢动脉硬化闭塞症

目的探讨Silverhawk斑块旋切系统治疗下肢动脉硬化闭塞症的安全性及近期疗效。方法对术前超声及MRA检查诊断为下肢动脉硬化闭塞症的10例患者行Silverhawk斑块旋切治疗,术后行常规抗凝治疗,定期彩色多普勒超声复查随访。结果 10例患者下肢动脉均再通成功,技术成功率100%,术后即刻缺血症状改善明显,术后平均踝肱指数为0.87±0.06,高于术前的0.26±0.06（P〈0.0001）。住院期间无并发症发生,随访3～15个月,中位随访时间9个月,患肢均保肢成功。结论使用Silverhawk斑块旋切系统治疗下肢动脉硬化闭塞症及支架内再狭窄、闭塞病变创伤小,安全性高,近期疗效显著。     

下肢动脉硬化闭塞症术后再闭塞的腔内治疗

<正>下肢动脉硬化闭塞症(arteriosclerosis obliterans,ASO)是动脉粥样硬化所致的慢性动脉闭塞性疾病,是全身动脉硬化性病变在下肢的重要表现,亦是周围动脉疾病(peripheral arterial disease,PAD)的重要组成部分。其病理基础为动脉内膜粥样硬化斑块形成、动脉中层变性和继发血栓形成,进而导致管腔狭窄甚至闭塞。传统的治疗方式有旁路血管移植术、血管内球囊扩张支架成形术,术后晚     

下肢动脉硬化闭塞性病变的介入治疗新技术

对于治疗下肢动脉硬化闭塞性疾病,传统的经皮血管腔内成形术因存在较高的再狭窄率而受到严重挑战,促使大量新技术不断涌现,以降低术后再狭窄率。这些新技术包括各种新型球囊及支架的使用、完全闭塞性病变开通装置的使用、返回真腔装置的使用、激光成形术、斑块旋切术等,本文就这些新技术的进展情况进行综述。     

下肢动脉硬化闭塞症血管腔内治疗的研究进展

下肢动脉硬化闭塞性疾病是血管外科最常见的临床问题,传统的手术治疗创伤较大,术后并发症发生率高,而血管腔内治疗因其具有微创、高效、可重复操作等优点日益取代传统手术,成为动脉闭塞性疾病的首选方法。经皮腔内血管成形术和支架置入术是治疗外周血管狭窄闭塞性病变的主要腔内治疗方法。近年来随着介入器材的不断改进,该技术得到了迅猛的发展,适应证大大拓宽;切割球囊、冷冻血管成形术、斑块旋切、激光辅助系统及药物涂层等新技术的应用,有针对性地解决了特殊部位如动脉分叉处病变、严重钙化、病变弥散等问题。就血管腔内治疗的发展历程、应用现状和前景作一综述。     

SilverHawk斑块旋切结合置管溶栓治疗股腘动脉支架内再狭窄一例

SilverHawk斑块旋切术作为一种新的血管腔内技术,近2年来在我国应用于单纯股腘动脉狭窄及闭塞病变治疗.然而对支架内再狭窄(In-Stent Restenosis,ISR)和闭塞病变,首都医科大学宣武医院采用这一技术结合置管溶栓治疗,取得比较满意的效果,现报道如下. 临床资料 1.一般资料:患者男,71岁,因"右小腿间歇性跛行1年"于2011年12月31日入院行右股浅动脉支架成形术.3个月前患者再次出现右小腿间歇性跛行,跛行的距离200 m.于2012年6月27日再次入院.查体:右足皮温低,双侧股动脉可触及搏动,双侧胫后动脉、右足背动脉未触及搏动;ABI:右:0.52;左:0.84.辅助检查:下肢动脉Doppler超声:右股浅动脉支架内再闭塞,右腘动脉狭窄,左股浅动脉闭塞.诊断为下肢动脉硬化闭塞症(FontaineⅡb级),右股浅动脉支架后闭塞.     

股浅动脉长段硬化性闭塞的腔内治疗

下肢动脉硬化性闭塞症(arteriosclerosis obliterans,ASO)导致慢性下肢缺血,此时股浅动脉常受累,多为长段、多节段和溃疡型斑块性病变[1]。由于血管腔内治疗材料的发展和治疗技术的进步,以及手术微创、术后恢复快、适应证广等特点,腔内治疗股浅动脉长段(>5 cm)硬化性闭塞也越来越受到临床推崇。但由于病变段长及动脉硬化     

超声引导介入治疗外周动脉硬化闭塞症北大核心CSCD

目的探讨超声引导介入治疗外周动脉硬化闭塞症的安全性和可行性。方法2019年3月~2020年5月,对6例合并肾功能不全(4例)或造影剂过敏(2例)的外周动脉硬化闭塞症,在超声引导下行介入治疗,包括股浅动脉斑块旋切联合药物涂层球囊(drug coated balloon,DCB)扩张1例,股浅动脉狭窄DCB扩张1例,股浅动脉闭塞Rotarex血栓抽吸联合DCB扩张1例,股浅动脉狭窄球囊扩张、支架置入1例,髂动脉狭窄球囊扩张、支架置入1例,移植肾动脉狭窄支架内球囊扩张1例。结果6例手术均完成,其中2例使用5 ml造影剂辅助,无手术并发症。术后肾功能无恶化。5例下肢动脉病变者术后第2日踝肱指数较术前明显改善(0.46±0.22 vs.0.72±0.27,配对t检验,t=-4.125,P=0.015)。结论超声引导外周动脉介入治疗可以安全进行。     

下肢动脉硬化闭塞症减容治疗术中并发症及其处理

目的分析下肢动脉硬化闭塞症减容治疗术中并发症及其处理。方法回顾性分析167例接受减容治疗的下肢动脉硬化闭塞症患者(188肢),按照不同减容治疗方式分为溶栓组(43例46肢,接受置管溶栓术)、取栓组(42例49肢,接受机械血栓清除术)及旋切组(82例93肢,接受定向斑块旋切术)。分析各组术中并发症的种类、发生率、处理方式及治疗有效性。结果对溶栓组46条患肢均行置管溶栓术。取栓组中,16肢采用Angiojet取栓导管治疗,33肢采用Rotarex取栓导管治疗。旋切组中,21肢采用Silverhawk斑块旋切系统治疗,72肢采用Turbohawk斑块旋切系统治疗。减容治疗技术成功率为98.94%(186/188)。溶栓组、取栓组、旋切组并发症发生率分别为28.26%(13/46)、6.12%(3/49)及6.45%(6/93)。术中并发症包括血管破裂出血14例、栓子脱落引发栓塞5例、急性血栓形成2例及导丝断裂1例(1条患肢),分别给予压迫止血、覆膜支架植入、栓子抽吸、置管溶栓及断裂导丝抓捕处理,未出现治疗相关死亡者。3组间血管破裂出血发生率差异有统计学意义(P=0.002)。术后全部患者Rutherford分级较术前明显改善(Z=2.730,P=0.002)。结论减容治疗下肢动脉硬化闭塞症效果确切。血管破裂出血是术中最常见的并发症,且于置管溶栓术后并发症发生率最高;及时干预有利于避免造成严重后果。     

内膜下血管成形术治疗下肢动脉硬化闭塞症

动脉硬化闭塞症是一种退行性病变,是大、中动脉的基本病理过程,主要是细胞、纤维基质、脂质和组织碎片的异常沉积,在动脉内膜或中层发生增生过程中复杂的病理变化。在下肢动脉狭窄和闭塞性病变中比较常见。经典的治疗方法主要有药物、内膜剥脱术、旁路转流术和球囊扩张支架成形     

血管腔内成形术联合旁路术治疗动脉硬化闭塞症

动脉硬化闭塞症(arteriosclerosisobliterans,ASO)是动脉粥样硬化病变引起的慢性动脉闭塞性疾病,主要侵犯腹主动脉下段、髂股动脉等大、中型动脉,表现为下肢动脉缺血。随着人们饮食结构的改变,摄入含脂肪、胆固醇食物增多,ASO的发病率呈上升趋势,目前已是国内外血管外科的主要疾病之一。目前,治疗ASO的方法主要有传统的动脉旁路术、动脉内膜剥除术,血管腔内技术包括球囊扩张血管成形术、激光血管成形术、机械经皮腔内斑块旋切术、腔内血管超声消融、支架放置术及腔内联合旁路术。本文将对ASO的治疗方法进行总结比较,并着重讨论血管腔内…     

经皮腔内血管成形术治疗髂-股动脉狭窄或闭塞

目的探讨经皮腔内血管成形术（PTA）及血管内支架植入术治疗髂-股动脉狭窄或闭塞的应用价值。方法 66例髂-股动脉狭窄或闭塞患者,患肢均有不同程度的缺血症状,均采用PTA和（或）支架植入术进行介入治疗,分别于治疗前、后测定踝/肱指数（ABI）。结果 66例患者成功完成介入治疗,共植入支架73枚,其中髂动脉植入27枚,股浅动脉植入32枚,髂-股动脉植入14枚,无严重并发症发生。术后患者患肢缺血症状明显减轻或消失。ABI由术前0.39±0.12上升至0.72±0.15,术后随访3～24个月（平均15个月）,10例患者因复发而再次接受介入治疗。结论 PTA及血管内支架植入术,因其创伤小、可重复性高、疗效显著等特点已成为治疗髂-股动脉狭窄或闭塞的有效手段。     

Minimally invasive revascularization strategies for chronic lower limb ischemia

Lower extremity wounds resulting from ischemia are increasingly becoming a common indication for surgical revascularization. Techniques in minimally invasive vascular surgery for the treatment of lower extremity chronic ischemia have expanded rapidly in recent years. The current standard of care with which all new modalities should be compared is the restoration of arterial flow via direct arterial revascularization using the autogenous reversed saphenous vein that can yield limb salvage rates of approximately 95%. Percutaneous transluminal angioplasty and stenting (PTA/S), cryoplasty, catheter-directed atherectomy, laser-assisted PTA/S, drug-eluting stents, and subintimal angioplasty are emerging minimally invasive modalities used for the treatment of lower extremity ischemia. Early success rates using many of these techniques have been promising. The outcomes of randomized controlled trials with long-term follow-ups are needed to make confident remarks about the effectiveness of these techniques.     

Functional cineangiography in the diagnosis of arterial occlusive diseases of the lower extremities

An analysis of cineangiograms of lower extremity arteries of 225 patients with occlusive lesions of the abdominal aorta and lower extremity arteries has been made. Symptoms detected by cineangiography are described which allow to judge on stenotic lesions of the arteries with greater reliability than by the data of serial angiography. Quantitative analysis of cineangiograms has been performed with the determination of time of blood flow along arterial segments.     

Duplex imaging of lower extremity bypasses, angioplasties, and stents

Duplex scan surveillance after lower extremity bypass and endovascular interventions can have a favorable impact on outcome. Its application during an arterial intervention to exclude technical or hemodynamic abnormalities and as part of a postoperative surveillance program to detect stenosis has been shown to improve patency. Results of duplex imaging can identify the arterial reconstruction at high risk of failure/thrombosis, which requires more intensive surveillance. Based on stenosis severity and anatomy, duplex scanning can suggest which repair technique (open surgery vs percutaneous balloon angioplasty [PTA]) is more appropriate. The use of duplex imaging during PTA of graft or peripheral artery stenoses (duplex-monitored balloon angioplasty) is recommended to verify normalization of velocity spectra, because this end point is associated with improved stenosis-free patency. A duplex surveillance program combined with correction of progressively stenotic lesions is recommended after lower limb bypass and PTA.     

下肢动脉支架内再狭窄的诊断和治疗

随着人口老龄化的加重,下肢动脉狭窄与闭塞性疾病的发生率越来越高,同时伴随着腔内支架的广泛应用,支架内再狭窄的发生率也逐渐升高。目前治疗支架内再狭窄的技术主要有药物治疗、普通球囊、药涂球囊、金属裸支架、药物洗脱支架、腔内减容（激光、旋切）和旁路搭桥术等。单一治疗方法效果均有限,而腔内减容与药涂球囊联合既可以机械去除增生的内膜,又可以有效抑制内膜再增生,是目前治疗支架内再狭窄较为合理的方法。     

Selection of patients with lower limb arterial occlusive disease for endovascular treatment of the iliac arteries with duplex scanning

The aim of this study was to evaluate the role of duplex scanning in selection of patients with lower limb arterial occlusive disease for endovascular treatment of the iliac arteries. From January 1995 through May 2000, 183 patients having chronic lower limb arterial insufficiency who underwent duplex scanning of the lower extremity arteries with available aortoiliac scans within 3 months before conventional aortoiliac diagnostic angiography and/or endovascular intervention of the iliac arteries were studied retrospectively. The findings obtained from duplex scanning and angiography were analyzed in a blinded manner by 2 investigators. Limbs having category 1, 2, and 3 lesions according to duplex scan findings were interpreted as being suitable for endovascular intervention. The comparison between duplex scan findings and angiography was analyzed by the third investigator. During 93 percutaneous transluminal angioplasty (PTA) procedures, 133 arterial segments, common or external iliac, were dilated with stent placement in 70. Bilateral interventions were performed in 25 cases, and of 68 unilateral interventions, 57 were at only 1 arterial segment. The accuracy, sensitivity, specificity, and negative and positive predictive values of duplex scanning to appropriately categorize the iliac artery lesions into suitable or unsuitable for endovascular intervention were 90%, 95%, 83%, 90%, and 92%, respectively when the inconclusive duplex scans were excluded (11%). In 6 patients with lesions suitable for PTA according to duplex scanning and angiography, PTA was not performed owing to clinical reasons. The accuracy of duplex scanning in predicting the performance of endovascular intervention was 88%. It is concluded that iliac artery endovascular procedures in limbs with chronic occlusive disease can be reliably planned according to duplex scan findings.     

Recent advances in atherectomy and devices for treatment of infra-inguinal arterial occlusive disease

The prevalence of peripheral arterial disease (PAD) continues to rise in an ever ageing society and consumes a significant part of health resources. Percutaneous revascularization has revolutionized the treatment of lower extremity peripheral vascular disease over the past 10 years. Additionally, novel devices have allowed improved endovascular treatment of femoropopliteal as well as infrapopliteal disease. Although percutaneous transluminal angioplasty (PTA) can be an effective modality for focal lesions in the iliac arteries, the results for complex infra-inguinal arterial disease have been disappointing. One class of new technology has concentrated on debulking the plaque, while others focus to improve safety (distal embolic protection devices) or are directed to specific clinical challenges such as chronic total occlusions. However, the lack of uniform performance criteria and reporting standards for these and other devices has resulted in heterogeneous study end points, making comparative efficacy difficult. Here we review the current data for atherectomy and atheroablative technologies as well as other adjunctive devices in the treatment of lower extremity peripheral arterial disease.     

The disproportionate growth of office-based atherectomy

Objective

The purpose of this study was to evaluate the trends in procedure volume, clinical sites of care, and Medicare expenditure for peripheral vascular interventions (PVIs) for lower extremity occlusive disease since the Centers for Medicare and Medicaid Services instituted reimbursement policy changes that broadened payment for procedures performed in physician-owned office-based laboratories (OBLs).

Percutaneous transluminal angioplasty for the treatment of limb threatening ischemia: Do the results justify an attempt before bypass grafting?

Purpose: Results of percutaneous transluminal angioplasty (PTA) in selected cases have been reported to be equal or superior to those of arterial bypass graft surgery, with a lower morbidity and mortality. We performed PTA of stenotic or occlusive lesions in patients with limb-threatening ischemia, hoping to improve our overall success and decrease morbidity in this group of patients. The results of PTA in the limb-salvage setting was evaluated. Methods: From 1992 to 1995, 307 PTAs were performed in 257 patients. One hundred sixty-one (63%) patients had diabetes mellitus, and 32 (12%) patients had renal failure. All patients were evaluated by means of pulse volume recordings and ankle brachial indices at 1 and 6 weeks after PTA and at 3 month intervals thereafter. Seventeen patients (9%) were lost to follow-up. The continued success or failure of PTA was defined by means of noninvasive vascular laboratory criteria, patency by means of pulse examination, the need for subsequent bypass grafting across the index lesion, and limb salvage. Results: The 1-year patency rates for external iliac PTAs (56%) were significantly lower (P < .05) than those for common iliac PTAs (87%). Infrainguinal PTAs at the femoral, popliteal, and tibial level had 1-year patency rates of less than 15%. Conclusion: Common iliac artery PTA is justified in most cases in which it is feasible. However, when PTAs are performed below the inguinal ligament, the results are markedly worse. One-year patency rates of PTA in this group of patients with threatened limbs are inferior to the patency rates of arterial bypass grafts, even when these bypasses are performed with a prosthetic material. PTA should not be considered as a primary treatment modality for patients with infrainguinal arterial occlusive disease who also have limb-threatening ischemia, except in unusual circumstances. (J Vasc Surg 1998;28:1066-71.)