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.     

术中髂动脉支架结合股动脉旁路术治疗多节段动脉硬化闭塞症

目的 探讨术中髂动脉腔内成形及支架植入结合股-Guo动脉旁路术治疗多节段动脉硬化闭塞症的初步临床经验。方法 采用术中同时行髂动脉腔内成形和支架植入结合股-Guo动脉旁路术治疗多节段动脉硬化闭塞症10例（12条肢体）。结果 术中11条髂动脉行腔内成形和支架植入均获成功,9条肢体行股-Guo动脉人工血管旁路术,3条肢体行股-股-Guo动脉人工血管旁路系列转流术;1条肢体股-Guo动脉旁路术失败,本组患者无重要脏器并发症和手术死亡。平均随访时间6个月（1-12个月,髂动脉腔内支架通畅率100%;3条股-股动脉耻骨上人工血管转流均通畅;而股-Guo动脉人工血管通畅率83.3%;截肢率8.3%。结论 术中髂动脉腔内支架结合股-Guo动脉旁路术是治疗多节段动脉硬化闭塞症的安全、有效方法。     

多节段下肢动脉硬化闭塞症介入治疗及手术治疗体会

目的 总结一侧髂动脉闭塞合并下肢动脉长段闭塞患者治疗的临床效果.方法 对于一侧髂动脉同时合并下肢动脉长段闭塞的多节段下肢动脉硬化闭塞症患者,间歇跛行距离小于50m或有静息痛者采用髂动脉支架或联合血管旁路术治疗下肢动脉硬化闭塞症32例.结果 行髂动脉病变段球囊扩张及内置支架术29例36枚支架,3例髂动脉介入治疗失败,行股浅动脉病变段支架置入3例,行股-腘动脉膝上血管旁路术13例,行膝下血管旁路术2例,3例髂动脉支架治疗失败者2例行股-股动脉耻骨上旁路术,1例放弃治疗.介入治疗及手术治疗均取得成功.随访3～36个月,3例患者因肿瘤或急性心肌梗塞死亡,大部分患者临床症状消失.1例股浅动脉支架1个月后闭塞,后因肢体严重缺血截肢.3例股-腘旁路血管闭塞,1例接受取栓手术好转,1例截肢,1例无静息痛间歇跛行距离大于50m应用药物治疗.结论 支架置入或联合血管旁路术是治疗多节段下肢动脉硬化闭塞症的安全有效方法 .     

药物涂层球囊和普通球囊治疗股腘动脉支架内再狭窄的临床疗效比较

目的:比较药物涂层球囊和普通球囊治疗下肢股腘动脉硬化闭塞症患者腔内治疗后支架内再狭窄的疗效。方法:回顾性分析2016年7月至2017年12月于山西白求恩医院血管外科因下肢股腘动脉硬化闭塞症腔内治疗后支架内再狭窄行手术治疗的91例患者的临床资料,并比较两组患者术后的一期通畅率。结果:43例使用药物涂层球囊,48例使用普通...     

PTA及血管内支架治疗下肢多节段动脉硬化闭塞症的应用

目的 探讨经皮腔内球囊扩张血管成形术及血管内支架治疗下肢多节段动脉硬化闭塞症的临床应用价值.方法 全组11例,共18条患肢(闭塞病变22个节段).15段闭塞长度在7cm以内者作PTA,病灶分别位于髂总动脉6段、器外动脉2段、股浅动脉7段;15段中有4段与PTA同时置入血管内支架.另外长段闭塞的7段,于短段作PTA同时或在术后1周内作动脉重建术,其中腹主-股总动脉转流术1段、腹主-股深动脉1段、股-腘动脉3段、腘动脉间置移植术1段、股深动脉成形术1段.结果 1条患肢因PTA失败即改作转流术,2条患肢术后并发股浅动脉急性栓塞,作取栓治疗后,均恢复血循环.术后近期内,全组18条患肢临床症状改善,其中16条末梢动脉搏动恢复,踝/肱指数由术前0.54±0.11增高至0.79±0.15.随访6～72个月后,2条作PTA患肢的股浅动脉分别于1年和5年后再次闭塞.结论 经皮腔内球囊扩张血管成形术是治疗下肢动脉闭塞性疾病的有效方法,血管内支架置放有助于提高通畅率,多节段动脉闭塞性病变联合手术重建,可简化手术操作,缩小手术创伤.     

复合球囊扩张治疗股浅动脉长段闭塞

股浅动脉长段闭塞是血管旁路手术和血管内支架治疗的适应证,但是一些年龄大、合并症多的老年人不愿接受开放性手术,而血管内长段支架长期的通畅率很低[1].黑龙江省医院南岗分院自2009年6月至2010年7月应用常规长球囊与切割球囊配合的“复合球囊扩张”治疗动脉硬化闭塞症股浅脉长段闭塞患者11例,取得较好效果,现报道如下.     

经腘动脉入路逆行内膜下血管成形术治疗股浅动脉长段硬化性闭塞症的临床研究

目的:探讨经腘动脉入路逆行内膜下血管成形术/支架置入术处理常规入路腔内顺行开通失败的股浅动脉长段硬化性闭塞症的疗效及可行性。方法:50例股浅动脉长段硬化性闭塞症患者行股动脉病侧顺行或健侧逆行推进导丝、导管时无法通过病变动脉到达闭塞段远端的真腔,遂行经腘动脉逆行入路完成内膜下血管成形术。结果:手术即刻支架置入成功率100%,12个月一期通畅率48.0%,二期通畅率92.0%。与术前比较,患者术后踝肱指数(ABI)明显升高,Rutherford分级明显改善(均P0.05)。5例患者术后出现肢体肿胀,3例患者于术后3个月出现腘动脉假性动脉瘤,经治疗均好转。术后1年,再狭窄患者16例(32.0%)。结论:常规入路腔内顺行开通失败的股浅动脉长段硬化性闭塞症患者转行经腘动脉入路逆行内膜下血管成形术/支架置入术有效、可行。     

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。     

内膜下血管成形术治疗股腘动脉硬化闭塞症

目的探讨内膜下血管成形术(SIA)治疗长段股腘动脉硬化闭塞的临床疗效及其技术要点。方法回顾性分析2009年6月～2011年8月我院收治的20例TASCⅡC型、D型股腘动脉硬化闭塞患者的临床资料,采用SIA开通长段闭塞管腔,同时行球囊扩张和支架植入术,以踝/肱指数(ABI)、Fontaine分期、保肢率和通畅率综合评估临床疗效。结果 SIA技术成功率为85%,临床症状改善率为90%,保肢率为95%,一期通畅率为83.3%,ABI从术前0.42±0.07提升至术后0.86±0.14,术前、术后比较差异有统计学意义(P<0.01)。术后随访12～24个月,18例临床症状改善的患者中有3例术后3～6个月症状复发,行第二次介入治疗,其余患者症状均无加重或复发。结论 SIA在治疗股腘动脉硬化闭塞症中具有良好的应用价值,方法安全有效,近期通畅率较好,远期通畅率尚需要进一步随访。     

微创技术结合外科手术治疗重症下肢缺血

目的 探讨术中血管微创治疗技术结合外科手术治疗重症下肢缺血的初步临床经验。方法 1999年7月至2000年10月,采用术中同时行髂动脉腔内微创治疗技术(球囊扩张和支架植入)结合肢体远端动脉重建术治疗广泛多节段动脉硬化闭塞症15例(20条肢体)。结果 术中17条髂动脉微创介入治疗均获成功,11条肢体同时行股-腘动脉人工血管旁路术,3条肢体行股-股-腘动脉人工血管旁路系列转流术,5条肢体行股深动脉成形术。其中有1条肢体股-腘动脉旁路术失败。本组患者无重要脏器并发症和手术死亡。平均随访时间8个月(1-16个月),髂动脉腔内支架通畅率100％,3条股-股动脉耻骨上人工血管转流均通畅,而股-腘动脉人工血管通畅率78．6％,截肢率10．0％。结论 术中髂动脉腔内微创介入治疗技术同时结合远端动脉重建术是治疗广泛多节段动脉硬化闭塞症的害全右特肯沸．     

胫腓动脉血管成形术治疗下肢严重缺血35例

目的 评价胫腓动脉经皮血管腔内成形术(percutaneous transluminal angioplasty,PTA)治疗下肢严重缺血的可行性、安全性和有效性.方法 对2004年6月至2007年5月收治的35例胫腓动脉闭塞的下肢严重缺血(critical limb ischemia,CLI)患者应用PTA治疗.评价的主要参数为:胫腓动脉PTA技术成功率、通畅率、救肢率和并发症.结果 胫腓动脉PTA的技术成功率为83%,平均随访11.5个月,通畅率为57%,救肢率82%.胫腓动脉平均扩张长度9.5 cm(4.5～14 cm),19例患者同时行髂或股胭动脉PTA或支架术.有3例并发症发生,其中1例动脉痉挛和血栓形成,经溶柃、解痉等治疗缓解;2例动脉穿孔,未有严重后果.结论 PTA治疗CLI合并胫腓动脉闭塞具有较高技术成功率和救肢率,较少发生严重并发症,是一种安全、有效可供选择的治疗方法.     

Homocysteine levels, haemostatic risk factors and patency rates after endovascular treatment of the above-knee femoro-popliteal artery.

OBJECTIVES: To investigate the relationship between plasma homocysteine and other haemostatic variables and restenoses or reocclusions after endovascular treatment of symptomatic atherosclerosis of the above-knee femoro-popliteal artery. DESIGN: Prospective observational study. SETTING: University hospital. PATIENTS AND METHODS: The study included 103 patients (116 limbs), treated with subintimal angioplasty in 58 cases (50%) and with intraluminal PTA in 58 (50%): 39 (34%) patients were treated for critical limb ischaemia. Blood samples for analyses of fasting plasma values of homocysteine, fibrinogen, D-dimer, activated protein C resistance were drawn upon admission. Median follow-up for all procedures was 11 months (range 0-42 months). Outcome events (arterial patency) were defined as > or =50% restenosis or reocclusion in the treated arterial segment. Patency rates were estimated with the product limit method and Kaplan-Meier curves. Variables found to be related significantly to patency were included in multivariate analysis performed with the Cox proportional hazard model. RESULTS: The 1-year cumulative primary patency rate for all procedures was 48%. One-year limb salvage rate in cases of critical ischaemia was 74%. Multivariate analysis demonstrated significant independent associations between patency rates and plasma D-dimer, diabetes mellitus, the nature of the lesion treated (stenosis vs. occlusion) and antithrombotic therapy with aspirin after the procedure. Plasma levels of homocysteine, fibrinogen or activated protein C resistance were not associated with patency rates. Homocysteine levels were higher in patients with critical limb ischaemia than those with intermittent claudication. CONCLUSIONS: Early restenosis or reocclusion after endovascular intervention of lesions in the above-knee femoro-popliteal artery was more frequent following treatment of occlusion (versus stenosis), for patients with diabetes, patients with elevated D-dimer and those without antithrombotic therapy after the procedure. Plasma homocysteine did not appear to influence the outcome of endovascular intervention.     

Percutaneous transluminal angioplasty of the femoropopliteal arteries in limbs with chronic critical lower limb ischemia.

PURPOSE: The aim of the study was to evaluate the results of percutaneous transluminal angioplasty (PTA) of femoropopliteal arteries in patients with subcritical or critical lower limb ischemia.Materials and Methods: Ninety-two patients underwent 121 PTA procedures, 68 were of the superficial femoral artery (SFA), 13 of the popliteal and 40 of both arteries. Fifty-seven procedures were performed for treatment of occlusions. Eighty-four patients (94 procedures) were monitored with duplex scanning. RESULTS: Technical success rate was 88%. Primary success rates at 12 and 60 months in the whole series were 40% and 27%, respectively. The primary success rate in limbs with SFA occlusion of longer than 5 cm was only 12% after 5 years compared with 32% if the occlusion was 相似文献   

Reconstructive surgery on the femoro-popliteal segment in combination with lumbar sympathectomy

Long-term results of 660 reconstructive surgeries on the arteries of the femoro-popliteal segment performed from 1975 to 2002 are analyzed. Two hundred and twenty-eight (34.5%) of them were combined with lumbar sympathectomy (LSE) on the affected side. It was demonstrated that LSE influences outcomes of reconstructions on the femoro-popliteal segment. This influence depends on a primary degree of leg ischemia. At the stage of intermittent claudication LSE permits to improve patency of the femoro-popliteal segment, salvage of the leg, to decrease the rate of postoperative complications due to reduction of thrombosis and purulation rates. The rate of cardiovascular complications increases. In critical limb ischemia effect of LSE is opposite. It increases the rate of repeated occlusions and amputations compared with reconstructive surgeries without LSE. The rate of postoperative complications also increased due to thrombosis and cardiovascular complications. It is concluded that LSE is the factor improving outcomes of reconstructive surgery on the femoro-popliteal segment, but it must be used differentially. It is necessary to perform LSE during all reconstructive surgeries in patients with intermittent claudication and without serious cardiovascular diseases. In critical limb ischemia and serious concomitant cardiovascular diseases LSE must be avoided.     

Excimer laser assisted angioplasty for the treatment of critical limb ischemia

Two decades after the clinical introduction of percutaneous transluminal angioplasty (PTA), controversy still exists about the role of PTA for the treatment of occlusive disease in the femoropopliteal and infragenicular arteries. For the patient with critical limb ischemia (CLI), where diffuse disease and long occlusions are the rule, the results with PTA have not been optimal. Surgical revascularization has long been considered the gold standard for this patient population, but this procedure is associated with significant morbidity and mortality and up to 37% of patients may be poor surgical candidates. With advances in laser catheter design and refinement of recanalization techniques, improved results have been seen with laser assisted angioplasty of complex peripheral arterial disease. There has been renewed interest in excimer laser angioplasty for the treatment of patients with long total occlusions and diffuse disease who otherwise would have limited options for treatment. Excimer laser assisted angioplasty has been shown to be a successful approach to the treatment of long occlusions in the superficial femoral artery. Data from the recently completed Laser Angioplasty for Critical Limb Ischemia Phase 2 Trial (LACI) suggest that this is a viable treatment strategy for patients with CLI who are otherwise not good candidates for bypass surgery.     

腘以远动脉闭塞所致下肢严重缺血的血供重建

目的 评价腘以远动脉闭塞所致下肢严重缺血(critical limb ischemia,CLI)的血供重建.方法 回顾性分析2003年12月至2009年1月,腘以远动脉闭塞所致CLI行经皮血管腔内成形(percutaneous transluminal angioplasty,PTA)和开放性重建(open reconstruction,OR)术的患者,详细记录患者的病史、病变特点、手术过程、并发症和随访信息.采用Kaplan-Meier生存分析重建血管通畅率和救肢率.结果 本组腘以远动脉闭塞所致CLI患者共167例,182条患肢.123条动脉硬化闭塞(arterios-clerosis occlusions,ASO)的患肢行腘以远动脉PTA治疗,33条血栓闭塞性脉管炎(thromboangiitis obliterans,TAO)和23条ASO患肢行腘以远动脉OR手术.PTA再管化通道6、12、24个月的通畅率分别是67%、54%和49%,其救肢率分别是91%、85%和78%,OR术后移植物6、12、24个月的通畅率分别是90%、83%和79%,其救肢率分别是92%、87%和80%,PTA重建血管的通畅率低于开放性手术(P＜0.05),但PTA和OR术的救肢率差异无统计学意义(P＞0.05).结论 对腘以远动脉ASO的CLI患者,PTA有效、安全,可作为首选治疗方式.PTA治疗失败可选择OR术.对TAO患者腘以远动脉闭塞者OR术仍是最好的治疗选择.

Abstract：

Objective To assess reconstructive options for critical limb ischaemia in infrapopliteal arteries. Methods A retrospective review of all CLI patients who underwent infrapopliteal reconstruction was carried out. Patient history, demographics, procedure details, complications, and follow-up information were collected and analyzed. Patency, limb salvage rate was determined by Kaplan-Meier analysis. Results During the period (from December 2003 to January 2008 ), 123 CLI patients with arteriosclerosis occlusions were treated on an intention-to-treat basis with infrapopliteal percutaneous transluminal angioplasty (PTA).Thirty-three thromboangiitis obliterans and twenty-three arteriosclerosis occlusions suffering CLI were treated by infrapopliteal bypass procedures. Primary patency and limb salvage rate of infrapopliteal PTA at 6, 12 and 24 months was 67%, 54%, 49% and 91%, 85%, 78% respectively, Primary patency and limb salvage rate of infrapopliteal surgical bypass at 6, 12 and 24 months was 90%, 83%, 79% and 92%,87%, 80% respectively, the patency of infrapopliteal PTA was lower than infrapopliteal surgical bypass (P ＜0. 01 ), but the limb salvage rate of infrapopliteal PTA and open surgery was no significant difference (P ＞ 0. 05 ). Conclusion Endovascular treatment (PTA) in patients with infrapopliteal arteriosclerosis occlusions and critical ischaemia is safe, effective. Infrapopliteal PTA can be used as the choice of therapy and surgical bypass reserved in those endovascular treatment failed. While in CLI patients with thromboangiitis obliterans infrapopliteal artery bypass remains the best treatment option.     

Peripheral Angioplasty as the First-choice Revascularization Procedure in Diabetic Patients with Critical Limb Ischemia: Prospective Study of 993 Consecutive Patients Hospitalized and Followed Between 1999 and 2003

OBJECTIVE: To evaluate the effectiveness of peripheral angioplasty (PTA) as the first-choice revascularisation procedure in diabetic patients with critical limb ischemia (CLI). DESIGN: Prospective study. METHODS: PTA was employed as first choice revascularisation in a consecutive series of diabetic patients hospitalized for CLI between January 1999 and December 2003. RESULTS: PTA was successful performed in 993 patients. Seventeen (1.7%) major amputations were carried out. One death and 33 non-fatal complications were observed. Mean follow-up was 26+/-15 months. Clinical restenosis was observed in 87 patients. The 5 years primary patency was 88%, 95% CI 86-91%. During follow-up 119 (12.0%) patients died at a rate of 6.7% per year. CONCLUSIONS: PTA as the first choice revascularisation procedure is feasible, safe and effective for limb salvage in a high percentage of diabetic patients. Clinical restenosis was an infrequent event and PTA could successfully be repeated in most cases.     

Three-year outcome of endovascular treatment of superficial femoral artery occlusion

HYPOTHESIS: Patency after primary percutaneous transluminal angioplasty (PTA) and stenting of superficial femoral artery (SFA) occlusions is better than historical experience with PTA alone. DESIGN: Consecutive case series of primary PTA with stenting, and follow-up with duplex imaging every 6 months (mean +/- SD follow-up, 32 +/- 15 months). SETTING: Veterans Affairs medical center. PATIENTS AND METHODS: Patients were 57 previously untreated men with 71 limbs having chronic atherosclerotic SFA occlusion with suprageniculate reconstitution and patent tibial runoff. Critical ischemia (Society for Vascular Surgery [SVS] category, 4-6) was present in 7 (10%), the remainder had intermittent claudication only (SVS, 1-3). INTERVENTIONS: Guidewire recanalization followed by PTA, Wallstent deployment, and adjunctive thrombolysis as necessary; 19 limbs (27%) required thrombolysis to manage periprocedural thrombosis. MAIN OUTCOME MEASURES: Cumulative patency, limb salvage, and complications. RESULTS: Length (mean +/- SD) of occlusion was 14.4 +/- 9.9 cm. Length of stented artery was 24.3 +/- 11.1 cm. Ankle brachial index increased from 0.59 +/- 0.14 to 0.86 +/- 0.16 (P<.001) after stenting. One- and 3-year patencies were as follows: primary, 54.6% +/- 6.3% and 29.9% +/- 6.6%; assisted primary, 72.3% +/- 5.6% and 59.0% +/- 6.8%; and secondary, 81.6% +/- 4.8% and 68.3% +/- 6.5%. Three-year secondary patency when periprocedural thrombolysis was required was 35.7% +/- 12.5% compared with 70.6% +/- 7.4% for limbs not requiring periprocedural thrombolysis (P=.02); the differences in occlusion length and severity of ischemia were not significant between these 2 groups. Limbs undergoing adjunctive PTA during angiography 6 to 12 months after initial stenting had 63.0% +/- 13.3% patency at 3 years compared with 100% patency in limbs not requiring PTA at 6 to 12 months angiography (P=.046). Periprocedural mortality and morbidity were 2.8% and 15.5%, respectively. Three of the 7 limbs with critical ischemia underwent amputation during follow-up compared with 2 (3%) of 64 limbs with functional ischemia (chi(2) test, P<.006). A mean of 1.8 endovascular interventions per limb were performed. CONCLUSIONS: Percutaneous transluminal angioplasty and stenting yielded higher patency rates than historical controls undergoing PTA alone. When periprocedural thrombolysis is required, subsequent patency appears to be significantly worse. Poor results after PTA and stenting of limbs with critical ischemia and the need for additional endovascular therapy limit the technique's utility.     

膝下动脉闭塞症的腔内治疗

目的探讨腔内术对膝下动脉闭塞疾病的治疗价值。方法回顾性分析2006年2月至2008年5月复旦大学附属中山医院血管外科收治的86例患有膝下动脉闭塞症的住院病人的病史资料和术后随访资料。结果86例病人（90条患肢）经经皮腔内血管成形术（PTA）治疗,82条患肢获得影像学成功（残留狭窄率＜30%）。技术成功率为911%（82/90）。术前1周和术后1周行下肢节段测压,踝肱指数（ABI）由术前的034±016提高到085±023。1年累计初次通畅率为612%,24月累积初次通畅率为495%,肢体保全率978%,存活率978%。结论PTA治疗膝下动脉闭塞症临床成功率高,并发症少,保肢率高,可以作为膝下动脉闭塞特别是重症肢体缺血的首选。