血管腔内治疗下肢动脉硬化闭塞症

目的评价血管腔内治疗下肢动脉硬化闭塞症的疗效。方法回顾性分析我院92例(120条患肢)接受腔内治疗的下肢动脉硬化闭塞症患者的临床资料,并随访其疗效。结果 116条患肢介入治疗获得技术成功,治疗后踝肱指数0.82±0.21,较术前(0.38±0.16)明显提高(P0.05)。术后3、6、12、24个月随访率分别为95.51%(85/89)、92.77%(77/83)、70.77%(46/65)、60.71%(17/28),相应动脉通畅率分别为90.99%(101/111)、86.00%(86/100)、77.97%(46/59)、65.22%(15/23)。2例股动脉支架内急性血栓形成,经置管溶栓术治愈;2例行膝下截肢术。结论血管腔内治疗下肢动脉硬化闭塞症安全、有效,远期效果尚需进一步观察。     

内膜下血管成形术治疗下肢动脉硬化闭塞症的初步报道

目的:总结内膜下血管成形术(SIA)治疗下肢动脉硬化闭塞症的疗效。方法:平卧位、局麻下,于病肢同侧顺行或逆向穿刺股总动脉,插入6F鞘管,造影证实闭塞病变。在电透荧屏监控下,通过鞘管插入5F的KMP导管,在0.035超硬导丝作用下,于闭塞端的侧壁内膜下开创一个夹层平面,随着导丝在内膜下向前延伸,其顶端会形成半圆形的环。然后,导管和导丝环通过内膜下的夹层持续前进;当到达闭塞段远端时,将KMP导管的顶端转向腔内,使导丝和导管进入真腔。然后退出导管,顺着导丝插入7mm×40mm或合适大小的球囊导管,应用709～811kPa压力,逐步扩张再管化段。术中如发现新形成的通道受压而呈弹性回缩现象,可以植入8mm×40mm或适当大小的镍钛合金自膨式支架。最后通过导管或鞘管造影,检测血流通道是否再建成功。结果:本组共13例,男9例,女4例;左下肢5条,右下肢6条,双下肢2例(4条),共15条肢体。11例中计13条肢体获得成功,成功率为86.7%。其中股动脉段闭塞5例(7条肢体),髂动脉闭塞段4例(4条肢体),胫闭塞段2例(2条肢体)。分别随访3～9个月(平均4.3月),均维持通畅。复查ABI为0.65～0.87,平均0.75,与术前比较有显著性差异(P<0.01)。结论:SIA是一种应用腔内血管外科技术治疗下肢动脉硬化闭塞症的新方法,操作简便微创,安全、有效而经济,近期     

药物涂层球囊治疗股腘动脉硬化闭塞症

目的 观察药物涂层球囊(DCB)治疗股腘动脉硬化闭塞症的价值。方法 纳入接受DCB治疗的98例共111侧股腘动脉硬化闭塞症患者,均于治疗前接受普通球囊逐级预扩张;病变长度5～46 cm、平均(25.19±10.63)cm,多为慢性完全闭塞性(CTO)病变及串珠样病变;Rutherford 3级及以下者占比38.74%(43/111);通过分析临床、手术及随访资料,评估DCB治疗股腘动脉硬化闭塞症的效果。结果 出院时Rutherford 3级及以下者占比增至95.50%(106/111)。70例患者(84肢病变)接受随访,期间4肢截肢、11肢接受靶病变血运重建(TLR);DCB治疗后股腘动脉一期通畅率为73.81%(62/84),二期通畅率为84.52%(71/84)。上述84肢中,对16肢以2个DCB、68肢以单个DCB进行扩张,其一期通畅率[75.00%(12/16)vs. 73.53%(50/68)]及二期通畅率[93.75%(15/16)vs.82.35%(56/68)]差异均无统计学意义(P均>0.05);其中13肢接受补救性支架植入术、71肢未植入支架,其一期通畅率[8...     

腔内治疗股髂动脉硬化性闭塞症58例临床分析

目的评价血管腔内治疗技术在股髂动脉硬化性闭塞症的临床应用及其疗效。 方法回顾性分析2010年1月至2014年1月佛山市第一人民医院收治的58例股髂动脉硬化性闭塞症患者的临床资料,术前所有患者均行CT血管重建检查,均采用球囊扩张后支架植入,术后进行临床随访。 结果58例均手术成功,手术成功率100%;踝肱指数由术前平均（0.72±0.12）上升到（0.87±0.14）,差异有统计学意义（t=13.839,P=0.001）。术后所有患者随访1年以上,11例于1年内出现支架再狭窄,术后1年内通畅率为81.0%。 结论腔内治疗股髂动脉硬化性闭塞症是一种创伤小、通畅率较高的手术方式。     

长支架植入治疗股腘动脉硬化闭塞症的临床研究

目的观察长支架治疗长段或多节段股腘动脉狭窄闭塞病变的可行性及近期疗效。方法 2008年11月—2010年10月收治60例(共70条肢体)股腘动脉硬化闭塞的患者,应用长球囊对狭窄或闭塞性病变进行扩张成形后植入自膨式长支架(长度8～20 cm)治疗;对合并膝下动脉硬化闭塞者(24条肢体)同期应用DEEP球囊进行扩张成形。观察技术成功率、术中及术后并发症发生率和临床疗效。结果股腘动脉球囊扩张和长支架植入的技术成功率为94.3%(66/70条肢体);同期膝下动脉球囊扩张成功率为83.3%(20/24条肢体),其中3例胫腓干因扩张后弹性回缩各植入支架1枚。术后患者临床症状均明显改善,静息痛消失;ABI由术前0.45(0.44±0.20)提高至0.84(0.86±0.24)(P<0.01)。仅在股浅动脉扩张后局部破裂形成肌间血肿2例,未发生其他并发症。结论长支架治疗长段或多节段股腘动脉狭窄闭塞病变是一种微创、安全、近期疗效好的治疗方法,远期疗效有待进一步观察。     

长段股腘动脉硬化闭塞的腔内治疗初步经验分析

目的 评价血管腔内治疗长段股咽动脉硬化闭塞的临床效果.方法 2006年4月～2009年1月采用血管腔内治疗长段股咽动脉硬化闭塞10例(共14条肢体),术中同时行股咽动脉血管腔内球囊扩张成形术及支架植入术.结果 手术技术成功率为90%,放置12个支架,术后12个月通畅率为70%,术后血管再狭窄率30%.结论 血管腔内成形治疗长段股咽动脉硬化闭塞是一种安全有效的治疗方法.     

经皮腔内血管成形术治疗下肢闭塞性动脉硬化患者的疗效及对ABI指数的影响

目的 探讨经皮腔内血管成形术治疗下肢闭塞性动脉硬化患者的疗效及对踝肱指数(ABI)指数的影响.方法 选取2015年6月至2019年5月于遂宁市中心医院行手术治疗的108例下肢闭塞性动脉硬化患者的病历资料,根据治疗方式不同分为观察组(n=59)和对照组(n=49).观察并比较两组患者治疗前后的ABI、间歇性跛行距离、血管...     

下肢闭塞性动脉硬化患者经皮腔内血管成形术结合血管内支架成形术后发生支架内再狭窄的影响因素

目的 探讨下肢闭塞性动脉硬化(ASO)患者经皮腔内血管成形术(PTA)结合血管内支架成形术后发生支架内再狭窄(ISR)的影响因素.方法 收集2018年1月至2019年2月于西安交通大学第一附属医院行PTA结合血管内支架成形术治疗的145例ASO患者的临床资料,根据术后是否发生ISR将患者分为发生组(n=31)与未发生组...     

膝下动脉通畅性对股腘动脉硬化闭塞性病变患者药物涂层球囊扩张术后一期通畅率的影响

目的 探讨膝下动脉通畅性对股腘动脉硬化闭塞性病变患者药物涂层球囊（DCB）扩张术后一期通畅率的影响。方法 收集2017年1月至2020年6月于成都中医药大学附属医院治疗的120例股腘动脉硬化闭塞性病变患者（共132条肢体）的临床资料,根据术前血管造影检查显示的通畅膝下动脉数目将患者分为A组（通畅膝下动脉≥2条,34例患者,40条肢体）和B组（通畅膝下动脉≤1条,86例患者,92条肢体）,并将术后1年一期通畅率较低的B组根据术后血管造影检查显示的通畅膝下动脉增加情况分为b1组（增加通畅膝下动脉,66条肢体）和b2组（未增加通畅膝下动脉,26条肢体）。分析膝下动脉通畅性对DCB扩张术后股腘动脉硬化闭塞性病变患者临床疗效的影响,并分析B组股腘动脉硬化闭塞性病变患者、DCB扩张术后1年一期通畅情况的影响因素。结果 两组患者的术后1年下肢相关病死率比较,差异无统计学意义（P>0.05）。A组患者的术后ABI、术后1年一期通畅率均高于B组患者（P<0.05）。亚组分析中,b1组患肢的术后1年一期通畅率高于b2组患肢（P<0.05）。单因素分析结果显示,发生主要终点事件患者的术后流...     

对比Viabahn覆膜支架与金属裸支架治疗股腘动脉硬化闭塞症效果:Meta分析

目的 采用meta分析方法对比Viabahn覆膜支架与金属裸支架（BMS）治疗股腘动脉硬化闭塞症（ASO）的效果。方法 检索筛选中国生物医学文献数据库、万方医学网、中国知网、Embase、Web of Science、Cochrane Library和PubMed数据库关于以Viabahn覆膜支架（Viabahn组）及BMS （BMS组）治疗股腘ASO的随机对照研究,检索时间为建库至2022年4月30日;依据纳入及排除标准筛选文献。采用Cochrane RevMan 5.3软件分析组间技术成功率、12个月一/二期通畅率、靶病变血管重建（TLR）率和/或截肢率。结果 最终纳入9篇文献,含Viabahn组424例、BMS组469例共893例患者。Viabahn组12个月一期通畅率高于BMS组[比值比（OR）=1.90,95%CI（1.23,2.92）,P=0.004],而其TLR率低于BMS组[OR=0.44,95%CI（0.26,0.76）,P=0.003],组间技术成功率[风险差异（RD）=0,95%CI（－0.01,0.02）,P=0.59]、12个月二期通畅率[OR=1.48,95%CI（0.96,2.29）,P=0.07]及截肢率[RD=0,95%CI（－0.02,0.03）,P=0.79]差异均无统计学意义。结论 Viabahn覆膜支架及BMS用于治疗股腘动脉ASO可提高12个月一期通畅率、降低TLR率,二者12个月二期通畅率及截肢率相当。     

经皮腔内血管成形术联合血管内支架治疗下肢动脉硬化闭塞症

目的观察经皮腔内血管成形术(PTA)联合血管内支架治疗下肢动脉硬化闭塞症(ASO)的临床疗效。方法 2007年1月～2009年12月,对采用股动脉血管内支架治疗的26例下肢ASO患者的跛行距离及踝肱指数(ABI)进行观察。结果术后1个月,间歇性跛行距离由(124.6±32.2)m增加到(552.7±137.5)m,ABI由0.62±0.04增加到0.94±0.06,手术前后比较差异均有统计学意义(P<0.05)。术后1年支架通畅率为100%,2年通畅率为92.3%。结论 PTA联合血管内支架置放是治疗下肢ASO的有效方法。     

锁骨下动脉闭塞的血管腔内治疗

目的：探讨经皮血管内成形术(PTA)和血管内支架置放术治疗锁骨下动脉起始段闭塞的疗效。方法：应用经皮血管内成形术(PTA)和血管内支架安置术治疗5例锁骨下动脉起始段闭塞的病人。结果：5例手术均获成功。术后患肢动脉搏动恢复正常，多普勒测压双上肢血压压差由术前平均54mmHg降至术后9．6mmHg．术后随访1～3月；彩超提示支架无脱落及移位，病变部位血流通畅，椎动脉恢复为正常人颅血流。结论：PTA和血管内支架安置术是治疗锁骨下动脉起始段闭塞的一种微创、安全可行和疗效满意的方法。     

经皮腔内血管成形术联合支架置入治疗移植肾动脉狭窄的临床分析

目的  探讨经皮腔内血管成形术（PTA）联合支架置入治疗肾移植术后移植肾动脉狭窄（TRAS）的临床疗效。方法  回顾性分析21例肾移植术后TRAS行PTA联合支架置入治疗患者的临床资料。总结肾移植受者中TRAS的发生情况,比较TRAS患者介入治疗前后相关指标变化情况,分析TRAS患者的预后情况。结果  507例肾移植受者中有21例发生TRAS,发生率为4.1%（21/507）。TRAS诊断时间为术后5（4,7）个月,67%（14/21）在术后6个月内出现TRAS。与介入治疗前比较,介入治疗后1周和1个月TRAS患者血清肌酐、收缩压、舒张压以及移植肾动脉峰值血流流速均降低,估算肾小球滤过率（eGFR）、叶间动脉阻力指数均升高,差异均有统计学意义（均为P < 0.05）。PTA联合支架置入术后随访期间,共有1例出现移植肾动脉再发狭窄,经单纯球囊扩张后好转,1例右股动脉穿刺点假性动脉瘤形成,1例移植肾动脉闭锁导致肾脏萎缩失功,其余18例术后均恢复良好。结论  PTA联合支架置入是肾移植术后TRAS首选治疗方式,可明显改善移植肾功能,显著延长移植肾的生存时间。     

Treatment of Budd-Chiari syndrome with percutaneous transluminal angioplasty: report of a case

We report the successful treatment of Budd-Chiari syndrome (BCS) due to an obstruction of the hepatic veins. A 19-year-old man developed bleeding esophageal and gastric varices, and a large amount of ascites was thus caused by portal hypertension. BCS complicated by an obstruction of the major hepatic veins was diagnosed after examinations. We performed percutaneous transluminal angioplasty (PTA). This resulted in a great improvement of BCS, a marked decrease in the pressure of the hepatic veins, and the disappearance of ascites. Restenosis occurred at 1 year and 5 years after the initial angioplasty, for which PTA was repeatedly performed. Nine years after the initial treatment, no stenosis has been observed and the patient has shown a favorable outcome. Received: June 20, 2001 / Accepted: November 20, 2001     

Percutaneous transluminal renal angioplasty in neurofibromatosis

A 9-year-old boy with hypertension was found to have neurofibromatosis associated with stenosis of the right renal artery. Percutaneous transluminal angioplasty (PTA) was performed. Immediately post angioplasty angiography showed that the stenosis persisted, but over the next few days his blood pressure rapidly decreased and remained well controlled even when treatment was discontinued. The captopril stimulation test, performed after PTA, confirmed the return of plasma renin activity to normal values. A digital subtraction aortogram, performed 2.5 years after PTA, was unchanged. His blood pressure remained persistently normal, without anti-hypertensive agents. Based on these results, PTA is suggested as the first step in correcting renal artery stenosis due to neurofibromatosis. A complete anatomical resolution of the stenosis is probably not required since slight improvements in the renal artery lumen may be accompanied by important functional improvement.     

股浅动脉首期置入自膨式支架与球囊扩张成形的疗效比较

Objective To compare the mid-term clinical results of primary implantation of a selfexpanding nitinol stent and primary percutaneous transluminal angioplasty (PTA) for long range arteriosclerosis obliterans of the superficial femoral artery. Methods From December 2005 to February 2007,109 patients who had moderate-severe claudication or chronic limb ischemia (CLI)due to stenosis or occlusion of the superficial femoral artery were treated by endovascular technology. 53 patients (73 limbs) were treated by primary stenting and 56 patients (76 limbs)by PTA. We compared the clinical data of stenting group and PTA group at 6,12 and 24 months. Results The mean length of the treated segment was (16± 8)cm in the stenting group and(15±7)cm in the PTA group. At 6 months, the rate of restenosis on duplex ultrasonography was 13.7% in stenting group and 30.2% in PTA group (X2=4.09, P<0.05);at 12 months the restenosis rates were 25.5% in stenting group and 46.9% in PTA group(X2=4.75, P<0.05);at 24 months the restenosis rates on duplex ultrasonography were 38.1% in stenting group and 65.9% in PTA group(X2=6.66, P<0.01). Rutherford stages in stenting group were significantly better than those in PTA group. Conclusion In the mid-term, primary implantation of a self-expanding nitinol stent yielded results that were superior to those with PTA for arteriosclerosis obliterans or long range stenosis of the superficial femoral artery.     

股浅动脉首期置入自膨式支架与球囊扩张成形的疗效比较

Objective To compare the mid-term clinical results of primary implantation of a selfexpanding nitinol stent and primary percutaneous transluminal angioplasty (PTA) for long range arteriosclerosis obliterans of the superficial femoral artery. Methods From December 2005 to February 2007,109 patients who had moderate-severe claudication or chronic limb ischemia (CLI)due to stenosis or occlusion of the superficial femoral artery were treated by endovascular technology. 53 patients (73 limbs) were treated by primary stenting and 56 patients (76 limbs)by PTA. We compared the clinical data of stenting group and PTA group at 6,12 and 24 months. Results The mean length of the treated segment was (16± 8)cm in the stenting group and(15±7)cm in the PTA group. At 6 months, the rate of restenosis on duplex ultrasonography was 13.7% in stenting group and 30.2% in PTA group (X2=4.09, P<0.05);at 12 months the restenosis rates were 25.5% in stenting group and 46.9% in PTA group(X2=4.75, P<0.05);at 24 months the restenosis rates on duplex ultrasonography were 38.1% in stenting group and 65.9% in PTA group(X2=6.66, P<0.01). Rutherford stages in stenting group were significantly better than those in PTA group. Conclusion In the mid-term, primary implantation of a self-expanding nitinol stent yielded results that were superior to those with PTA for arteriosclerosis obliterans or long range stenosis of the superficial femoral artery.     

股浅动脉首期置入自膨式支架与球囊扩张成形的疗效比较

Objective To compare the mid-term clinical results of primary implantation of a selfexpanding nitinol stent and primary percutaneous transluminal angioplasty (PTA) for long range arteriosclerosis obliterans of the superficial femoral artery. Methods From December 2005 to February 2007,109 patients who had moderate-severe claudication or chronic limb ischemia (CLI)due to stenosis or occlusion of the superficial femoral artery were treated by endovascular technology. 53 patients (73 limbs) were treated by primary stenting and 56 patients (76 limbs)by PTA. We compared the clinical data of stenting group and PTA group at 6,12 and 24 months. Results The mean length of the treated segment was (16± 8)cm in the stenting group and(15±7)cm in the PTA group. At 6 months, the rate of restenosis on duplex ultrasonography was 13.7% in stenting group and 30.2% in PTA group (X2=4.09, P<0.05);at 12 months the restenosis rates were 25.5% in stenting group and 46.9% in PTA group(X2=4.75, P<0.05);at 24 months the restenosis rates on duplex ultrasonography were 38.1% in stenting group and 65.9% in PTA group(X2=6.66, P<0.01). Rutherford stages in stenting group were significantly better than those in PTA group. Conclusion In the mid-term, primary implantation of a self-expanding nitinol stent yielded results that were superior to those with PTA for arteriosclerosis obliterans or long range stenosis of the superficial femoral artery.     

股浅动脉首期置入自膨式支架与球囊扩张成形的疗效比较

Objective To compare the mid-term clinical results of primary implantation of a selfexpanding nitinol stent and primary percutaneous transluminal angioplasty (PTA) for long range arteriosclerosis obliterans of the superficial femoral artery. Methods From December 2005 to February 2007,109 patients who had moderate-severe claudication or chronic limb ischemia (CLI)due to stenosis or occlusion of the superficial femoral artery were treated by endovascular technology. 53 patients (73 limbs) were treated by primary stenting and 56 patients (76 limbs)by PTA. We compared the clinical data of stenting group and PTA group at 6,12 and 24 months. Results The mean length of the treated segment was (16± 8)cm in the stenting group and(15±7)cm in the PTA group. At 6 months, the rate of restenosis on duplex ultrasonography was 13.7% in stenting group and 30.2% in PTA group (X2=4.09, P<0.05);at 12 months the restenosis rates were 25.5% in stenting group and 46.9% in PTA group(X2=4.75, P<0.05);at 24 months the restenosis rates on duplex ultrasonography were 38.1% in stenting group and 65.9% in PTA group(X2=6.66, P<0.01). Rutherford stages in stenting group were significantly better than those in PTA group. Conclusion In the mid-term, primary implantation of a self-expanding nitinol stent yielded results that were superior to those with PTA for arteriosclerosis obliterans or long range stenosis of the superficial femoral artery.