肱动脉和股动脉穿刺入路支架成形术治疗单侧髂动脉慢性闭塞的比较研究

目的 比较左侧肱动脉和健侧股动脉穿刺入路腔内支架成形术治疗单侧髂动脉慢性闭塞患者的安全性、可行性和有效性.方法 回顾性分析2013年1月至2017年12月分别采用左侧肱动脉(A组)、健侧股动脉(B组)穿刺入路腔内支架成形术治疗的133例、116例单侧髂动脉慢性闭塞患者围手术期资料和随访结果.分别以围手术期并发症发生率、...     

介入腔内治疗在下肢动脉硬化闭塞症的应用

目的探讨下肢动脉硬化闭塞症（LEASO）的介入腔内治疗。 方法收集37例LEASO患者,共进行40次手术,处理病变血管56支,其中狭窄病变39处（39/56,69.64%）,闭塞病变17处（17/56,30.36%）,其中髂动脉病变19处(19/56,33.93%),股动脉病变30处(30/56,53.57%),胫动脉病变7处(7/56,12.50%)。 结果支架植入6处,球囊成形（PTA）9处,PTA+支架植入38处,手术成功率为94.64%（53/56）,术后30天内无死亡病例。手术成功病例术后临床症状明显改善或消失,术前踝肱指数（ABI）为0.35±0.05,术后明显升高(0.73±0.14,P<0.01)。 结论介入腔内治疗LEASO成功率高,安全可靠,可显著改善临床症状。     

经肱动脉行介入治疗下肢动脉硬化闭塞症患者的疗效观察

目的：研究经肱动脉行介入治疗下肢动脉硬化闭塞症患者的疗效。方法抽选2012年4月～2014年7月收治的下肢动脉硬化闭塞症患者98例,随机法分为观察组和对照组,每组各49例,观察组经肱动脉行介入治疗,对照组经股动脉入路介入治疗。比较两组患者手术效果及术前后ABI、TTS水平,对比患者并发症发生情况。结果观察组手术成功率、1年内复发率和死亡率与对照组比较,差异无统计学意义（ P＞0.05）。观察组一次性穿刺成功率与对照组比较显著较高,差异有统计学意义（ P＜0.05）。两组患者术前后ABI、TTS水平组间比较,差异均无统计学意义（ P＞0.05）。两组患者术后ABI、TTS水平与同组术前比较,差异有统计学意义（ P＜0.05）。两组并发症血肿、疼痛比例比较差异无统计学意义（ P＞0.05）。结论经肱动脉行介入治疗下肢动脉硬化闭塞症疗效确切,并发症少,临床治疗中可酌情选择肱动脉入路手术。     

经不同动脉入路治疗完全闭塞型自体动静脉内瘘的疗效及安全性观察

目的探讨经股动脉及肱动脉入路腔内血管成形术（percutaneous trans1uminal angioplasty,PTA）联合置管溶栓治疗完全闭塞型自体动静脉内瘘（arteriovenous fistula,AVF）的疗效、安全性及AVF远期通畅状况。 方法回顾性分析我院2016年3月至2018年6月期间收治的53例AVF闭塞且经动脉入路行PTA联合置管溶栓治疗的病例。分析患者基线资料、手术结局、并发症、射线暴露时间及剂量,随访观察患者AVF的通畅时间及通畅率。 结果经过治疗的53例AVF闭塞的患者中,成功48例,失败5例,总体技术成功率为90.6%;肱动脉入路组成功率优于股动脉入路组,两组之间差异有统计学意义（其中P<0.05）;两组之间并发症差异（P=0.234）及初级通畅率差异（P=0.278）无统计学意义;在统计手术射线暴露时间时发现,股动脉入路组射线暴露时间为（2 601.5±1 803.9）s,远长于肱动脉入路的（1 191.8±844.5）s,差异有统计学意义（P<0.05）;肱动脉入路组射线的暴露剂量为（25.15±26.06）mGy,明显小于股动脉入路组的剂量（97.58±69.85）mGy,差异有统计学意义（P<0.05）。 结论经股动脉及肱动脉入路PTA联合置管溶栓可以有效治疗完全闭塞型AVF,且术后的AVF在持续随访中有较好的远期通畅性;但在手术时射线暴露时间及剂量方面,肱动脉入路组明显优于股动脉入路组。     

慢性主-髂动脉闭塞内膜下再通治疗的可行性及初步应用

目的 探讨经动脉内膜下途径治疗主.髂动脉闭塞的可行性与治疗方法.方法 对1例慢性主髂动脉闭塞患者经右肱动脉穿刺,使用超滑导丝自腹主动脉闭塞端穿入内膜下腔,分别向两侧髂动脉行内膜下再通.右侧导丝顺利重入髂外动脉真腔,左侧使用了双向内膜下再通技术.2支导丝经双侧股动脉穿刺点引出体外.经两侧股动脉用对吻技术行球囊扩张和支架置放(主动脉下端支架1枚,双侧髂动脉支架5枚).结果主-髂动脉闭塞经内膜下途径成功再通.治疗后主.髂动脉支架内腔形态良好,血流通畅.双下肢缺血症状完全消失,踝臂指数(ABI)由0.32上升至0.96.10个月随访未见再狭窄表现.结论 经动脉内膜下途径治疗主.髂动脉闭塞安全、可行,适用于慢性动脉硬化闭塞病变.     

CTA和腔内治疗主髂动脉硬化闭塞症中的应用

目的：探讨CTA和腔内治疗在主髂动脉硬化闭塞症中的综合应用和疗效评价。方法：本组主髂动脉硬化闭塞患者共113例,其中男79例,女34例,年龄45~81岁,平均62.5岁。术前患者均常规行CTA检查,主髂动脉病变范围及程度根据TASCⅡ（The trans-Atlantic Inter-Society Consensus）分型,其中TASC A型42例（37.17%）,B型39例（34.51%）,C型患者13例（11.50%）,D型患者19例（16.81%）。腔内治疗经股动脉或肱动脉入路,采用通过闭塞段、球囊扩张、支架放置及股总动脉内膜剥脱等方法进行治疗。结果：107例患者主髂动脉闭塞病变获开通,开通率为94.7%。68例患者临床症状明显改善,39例中度改善。平均随访（26±2.3）月（6~54）月,术后6月、1年及2年的初次通畅率分别为82.76%、76.21%、67.66%,术后6月、1年及2年的二次通畅率分别为92.31%、81.67%、73.62%。结论：对于主髂动脉硬化闭塞的患者,综合应用CTA和腔内治疗是一项安全有效的措施,可获得满意的临床疗效。     

介入治疗髂、股动脉粥样硬化性闭塞的疗效观察

目的 探讨介入治疗髂、股动脉粥样硬化性闭塞临床疗效.方法 2007年7月至2009年4月,应用经皮血管腔内成形术(PTA)及支架置入术治疗下肢髂、股动脉粥样硬化性闭塞17例17条患肢.结果 13支髂、股动脉粥样硬化性闭塞成功行PTA及支架置入术,手术开通率76.5%(13/17),4条患肢行内科保守治疗.术后踝肱指数(...     

下肢动脉硬化性闭塞症的DSA

目的：为给外科手术提供更多信息，对１０５例下肢动脉硬化性闭塞症患者作术前经动脉数字减影血管造影（ＩＡＤＳＡ）检查。材料和方法：经皮动脉穿刺插管后，用非离子型造影剂作腹主动脉下段至双胫腓动脉ＤＳＡ。结果：ＤＳＡ表现有：动脉狭窄、闭塞、血管壁溃疡，血管扭曲、延长，侧支形成。本组有８３例（７９．０％）双侧髂、股动脉呈对称性闭塞和／或狭窄。结论：下肢动脉硬化闭塞症好发于老年男性、常双侧发病，股髂动脉最易受累，ＩＡＤＳＡ能满足手术医生术前了解病变的需要，其对患者的创伤较小，可作为术前的常规检查方法     

膝下动脉硬化闭塞症外科介入综合治疗早期疗效

目的探讨膝下动脉硬化闭塞症外科介入综合治疗的早期疗效。方法回顾分析2006年9月～2008年12月我科收治的24例26条肢体膝下动脉硬化闭塞症行球囊成形术,结合髂、股动脉支架置入和动脉取栓综合治疗的早期疗效。结果平均随访8．5个月,24例26条肢体膝下动脉硬化病变50条,球囊成形术成功疏通48条动脉。流入道病变予髂动脉支架置入4例,股动脉支架置入6例,股、胭动脉血栓取栓6例。术中并发导丝穿通血管壁2例。结论膝下动脉硬化闭塞症外科介入综合治疗的早期疗效好。     

膝下动脉硬化闭塞症介入治疗新进展

膝下动脉硬化闭塞症主要累及胫前动脉、胫后动脉和腓动脉,对于髂、股动脉等管径较粗的下肢动脉闭塞性病变的介入治疗已十分成熟,膝下动脉管径较细,病变范围较广,病变部位钙化广泛,治疗难度较大.治疗方法主要包括外科手术治疗、血管腔内治疗、药物治疗以及目前尚处于研究阶段的自体干细胞移植治疗.本文旨在介绍近年来膝下动脉硬化闭塞症介入治疗新进展,以及对未来的展望.     

改良式病员裤在行股动脉穿刺置管患者中的应用

目的：研究改良式病员裤在行股动脉穿刺置管患者术后护理中的应用效果。 方法：选取2018年6-12月在中山大学附属第五医院介入血管外科行股动脉穿刺置管术的患者100例,随机分为试验组和对照组,每组均50例。根据股动脉穿刺置管术后观察和护理的特殊需求,针对现有普通病员裤进行重新设计和改良制作成改良式病员裤。试验组穿改良式病员裤,对照组穿传统普通病员裤。比较患者与护士分别对两种病员裤在隐私保护、方便性、管路安全性、舒适性方面的满意度情况,比较护士在术后护理两组时所需的时间。 结果：试验组患者对改良式病员裤在隐私保护、方便性、管路安全性方面的使用满意度明显高于对照组[分别为90% vs. 14%,78% vs. 30%,84% vs. 34%],差异有统计学意义（P<0.001）;试验组护士为观察患者穿刺点和管道所需时间[（12.16±1.68）vs.（18.31±2.15）]和从管道处接尿激酶持续泵入所需时间[（21.61±2.65）vs.（50.44±7.99）]均小于对照组,差异有统计学意义（P<0.001）。 结论：改良式病员裤是一种便捷、实用、安全的病员裤,可以提高股动脉穿刺置管术后患者满意度,缩短护理工作时间。     

Angioplasty from the contralateral approach: use of a guiding catheter and coaxial angioplasty balloons

An 8-F guiding catheter has been developed for use with coaxial angioplasty balloon catheters in angioplasty of the femoral artery from the contralateral approach when antegrade puncture of the ipsilateral femoral artery is not possible. The catheter may be used for angioplasty of the femoral artery bifurcation and the superficial femoral artery and for arterial stenoses in patients with renal transplants.     

Postcatheterization pseudoaneurysms and arteriovenous fistulas: repair with percutaneous implantation of endovascular covered stents

PURPOSE: To assess the effectiveness and safety of endovascular covered stents in the management of pseudoaneurysms and arteriovenous fistulas after cardiac and vascular catheterization. MATERIALS AND METHODS: Twenty-six endovascular covered stents were used to repair 16 pseudoaneurysms, nine arteriovenous fistulas, and one combined lesion after femoral arterial puncture for diagnostic coronary angiography and/or angioplasty. Fistulas and aneurysms were in the superficial femoral artery in 16 cases, in the deep femoral artery in six cases, and in the common femoral artery in four cases. Implantation was performed from the opposite femoral artery in most cases. It was not possible to treat three additional cases transcutaneously for technical reasons (three of 29 cases). RESULTS: Percutaneous closure of the lesions with an endovascular covered stent was successful in 26 of 29 cases. Initial follow-up showed good stent patency. Two major complications were observed after stent implantation. During follow-up (about 1 year in 23 of 26 patients [88%]), stent thromboses were detected in four of 23 patients (17%) with follow-up color duplex flow imaging. CONCLUSION: Implantation of endovascular covered stents is an effective and safe method for the percutaneous closure of pseudoaneurysms and arteriovenous fistulas. Thus, endoluminal vascular repair with covered stents offers an alternative therapeutic approach to vascular surgery in selected patients.     

介入诊疗术后股动脉穿刺点并发症的诱因及预防

目的 探讨介入诊疗术后股动脉穿刺点并发症发生的原因及预防措施.方法 随机选取本院经皮股动脉穿刺介入治疗的600例患者为研究对象,记录选择的鞘管型号,观察介入医生穿刺技术的熟练度、操作手法的准确度、护士术前、术中、术后的配合度、护理工作的满意度以及患者的疾病程度等因素,综合分析导致介入诊疗术后股动脉穿刺点并发症发生的原因并提出预防措施.结果 术后股动脉穿刺部位出血、渗血4例;穿刺部位血肿3例;假性动脉瘤1例;股动脉夹层1例;股动脉血栓1例.结论 手术医生熟练的穿刺技术,轻柔的操作,介入护士较好的术前、术中、术后的严密观察与护理是预防经股动脉穿刺点并发症发生的关键.     

Subintimal Recanalization of Long Superficial Femoral Artery Occlusions Through the Retrograde Popliteal Approach

Purpose: To investigate the value of the retrograde popliteal artery approach for the percutaneous intentional extraluminal recanalization (PIER) of long superficial femoral artery (SFA) occlusions. Methods: During a period of 17 months, PIER through ultrasound-guided retrograde popliteal artery puncture was performed for 39 long SFA occlusions in 37 patients. In six patients, six additional iliac artery stenoses were also treated via the popliteal approach. Results: The procedure was technically successful in 32 (82%) of 39 SFA occlusions; in 29, lesions were treated with balloon angioplasty alone, and in three, stents were also used. Cumulative patency rate was 66% at 6 months, 62% at 1 year, and 59% at 18 months. Additional iliac artery stenoses were successfully treated in the same session. Complications included two minor hematomas and two SFA ruptures, which required no treatment. Conclusion: PIER through retrograde popliteal puncture is a safe and effective method in the treatment of long femoropopliteal occlusions, with a high technical success, low complication rate and a reasonable short-term patency rate. The technique offers an alternative in cases where standard PIER is unsuccessful or contraindicated.     

Wire-loop technique for angioplasty of total iliac artery occlusions

To recanalize occlusions of the iliac artery from an ipsilateral approach, the authors developed a technique in which the guide wire is manipulated through puncture sites in both sides of the groin. This technique was used in four occlusions (three in the common iliac artery and one in the external iliac artery); all occlusions were successfully dilated with balloon catheters. In two cases in which dilation was performed from the contralateral side, the contralateral iliac artery became occluded after the procedure. These occlusions were successfully dilated.     

Antegrade popliteal puncture: Technical note

Percutaneous transluminal angioplasty was performed via an antegrade popliteal puncture. This technique was utilized because the patient had a superficial femoral artery occlusion and coexistent popliteal stenoses, with the occlusion unable to be traversed in the usual common femoral artery antegrade approach. To our knowledge, this technique has not been described in the literature. The clinical utility of this approach and important anatomical considerations will be discussed.     

新型蝶式股动脉穿刺压迫装置在618例经股动脉行介入治疗患者中的应用效果

目的：观察新型蝶式股动脉穿刺压迫装置在经股动脉行介入治疗患者中的应用效果。 方法：选取2015年1月至2017年6月我科经股动脉穿刺行介入治疗的患者618例,平均年龄（60.9±8.2）岁,男406例,女212例。术中使用5F、6F、8F、10F动脉鞘管的患者分别为206、342、56、14例,术后均使用新型蝶式股动脉穿刺压迫装置进行穿刺口的压迫,分析患者的肢体制动时间及并发症发生情况。 结果：5F/6F动脉鞘管拔除后平均制动时间（12.0±4.6）h,8F/10F动脉鞘管拔除后平均制动时间（22.1±8.4）h。618例患者中有效613例,有效率99.2%,5例术后出现穿刺口血肿,经彩超检查3例确诊为假性动脉瘤,其中1例予以凝血酶注射,1例行手术治疗,1例延长压迫时间（48 h）,均痊愈,无严重皮肤过敏及破溃患者。 结论：新型蝶式股动脉压迫装置用于经股动脉行介入治疗后止血,具有操作简便、并发症发生率低、可在直视下有效止血、节时省力,且可同时行双侧股动脉压迫止血等优点,是较为理想的止血方法,值得在临床推广应用。     

Percutaneous iliofemoral angioplasty via the contralateral femoral artery.

Using a flexible balloon catheter, transluminal angioplasty of the lower extremities may be performed via a puncture of the contralateral extremity. Five cases which illustrate the usefulness of this technique are presented. It provides access to lesions not amenable to ipsilateral puncture, avoids the need to compress the dilated artery, and decreases the risk of significant hematoma formation.     

Bilateral brachial pull-through technique for stenting in a patient with stenosis of the vertebral artery origin: technical case report

Stenting for stenosis of the proximal vertebral artery (VA) is commonly performed via a femoral approach. However, iliofemoral occlusive disease such as arteriosclerosis obliterans sometimes prevents safe transfemoral access. In certain situations where both femoral access and ipsilateral brachial access are difficult because of a concomitant vascular diseases or particular anatomic setting, a contralateral brachial approach using the brachiobrachial pull-through technique may allow efficient and accurate stenting. A case of VA origin symptomatic stenosis successfully treated with stenting using the new pull-through technique from the contralateral brachial artery to the brachial artery on the affected side is described.