长段股浅动脉闭塞的内膜下成形术

目的 探讨内膜下成形术治疗长段股浅动脉闭塞的临床价值及中期随访结果.方法 采用内膜下成形术(subintimal angioplasty,SIA)治疗32例临床表现为间歇性跛行和重症下肢缺血的长段股浅动脉闭塞患者,对初始通畅率、保肢率及其影响因素、并发症等进行分析.结果 32例SIA成功31例,技术成功率96.9%,31例成功再通者6、12、24、36个月的初始通畅率分别为96.8%、78.9%、58.8%和47.0%.跛行患者和重症下肢缺血患者的初始通畅率比较,差异无统计学意义(P>0.05).膝下流出道血管数量和闭塞病变的长度对初始通畅率有影响(P<0.05,P<0.01).32例中仅2例截肢,保肢率93.8%.出现并发症2例,其中1例动脉穿孔,经植入支架后未发生严重后果;另1例为假性动脉瘤形成,经超声引导下注射凝血酶后消失.结论 SIA是治疗长段股浅动脉闭塞的有效方法,中期随访效果满意.     

44例食管带膜支架治疗晚期食管癌临床分析

目的 回顾性分析食管加膜支架对晚期食管癌患者吞咽困难的治疗效果及并发症的防治.方法 对44例晚期食管癌吞咽困难患者,在内镜直视下置入食管加膜支架,并观察其对吞咽困难的治疗效果.结果 44例患者均顺利置放 MTN 型形状记忆钛镍合金食管加膜支架,患者吞咽困难迅速得到缓解.主要并发症为胸痛.结论 食管加膜支架能明显改善晚期食管癌患者的吞咽困难,提高生活质量,延长其生存时间.     

A case of deep femoral artery aneurysm found with superficial femoral artery aneurysm

Objective: Deep femoral artery (DFA) aneurysms are extremely rare cases of aneurysms that are difficult to diagnose. The objective of this report was to discuss the timing and method of surgery for this disease.Patient: We encountered an asymptomatic left DFA aneurysm that was discovered along with a symptomatic aneurysm of the right superficial femoral artery (SFA). Both sides of the aneurysm were resected with Dacron knitted artificial vascular grafts (Gelsoft™ Plus, Vasctek, UK) simultaneously.Result: After the operation, the right SFA had good blood flow, but the graft of the left DFA was occluded. The occlusion was considered to be caused by insufficient blood flow in the graft. The patient was discharged without any complications.Conclusion: The coexistence of DFA aneurysms should be examined if other aneurysms are found. DFA aneurysms are at a high risk of rupture. Careful follow-up is required, and intervention is recommended when the diameter exceeds 35 mm.     

Chemical lumbar sympathectomy in patients with severe lower limb ischaemia.

Over a 13 year period, 544 chemical lumbar sympathetic blocks with phenol in 489 patients were performed by the author with the aid of X-ray image intensification. There was objective and subjective improvement in the signs and symptoms of limb ischaemia in 72%, judged by relief of rest pain, improvement in skin blood flow or healing of ischaemic ulcers. Of patients treated in the years 1990-1993, 44% had suffered either death or major amputation within two years of their treatment. Three serious and probably avoidable complications are described.     

Sirolimus-eluting stents vs paclitaxel-eluting stents in patients with coronary artery disease: meta-analysis of randomized trials

Context  Placement of sirolimus-eluting stents or paclitaxel-eluting stents has emerged as the predominant percutaneous treatment strategy in patients with coronary artery disease (CAD). Whether there are any differences in efficacy and safety between these 2 drug-eluting stents is unclear. Objective  To compare outcomes of sirolimus-eluting and paclitaxel-eluting coronary stents on the basis of data generated by randomized head-to-head clinical trials. Data Sources  PubMed and the Cochrane Central Register of Controlled Trials, conference proceedings from major cardiology meetings, and Internet-based sources of information on clinical trials in cardiology from January 2003 to April 2005. Study Selection  Randomized trials comparing the sirolimus-eluting stent with the paclitaxel-eluting stent in patients with CAD reporting the outcomes of interest (target lesion revascularization, angiographic restenosis, stent thrombosis, myocardial infarction [MI], death, and the composite of death or MI) during a follow-up of at least 6 months. Data Extraction  Two reviewers independently identified studies and abstracted data on sample size, baseline characteristics, and outcomes of interest. Data Synthesis  Six trials, including 3669 patients, met the selection criteria. No significant heterogeneity was found across trials. Target lesion revascularization, the primary outcome of interest, was less frequently performed in patients who were treated with the sirolimus-eluting stent (5.1%) vs the paclitaxel-eluting stent (7.8%) (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.49-0.84; P = .001). Similarly, angiographic restenosis was less frequently observed among patients assigned to the sirolimus-eluting stent (9.3%) vs the paclitaxel-eluting stent (13.1%) (OR, 0.68; 95% CI, 0.55-0.86; P = .001). Event rates for sirolimus-eluting vs paclitaxel-eluting stents were 0.9% and 1.1%, respectively, for stent thrombosis (P = .62); 1.4% and 1.6%, respectively, for death (P = .56); and 4.9% and 5.8%, respectively, for the composite of death or MI (P = .23). Conclusions  Patients receiving sirolimus-eluting stents had a significantly lower risk of restenosis and target vessel revascularization compared with those receiving paclitaxel-eluting stents. Rates of death, death or MI, and stent thrombosis were similar.      

Conservative management of acute thrombosis in the superficial femoral artery.

The management of acute occlusion of the superficial femoral artery due to thrombosis is controversial. Each of nine patients with this condition whom we treated conservatively improved clinically, apparently without any change in the perfusion of the limb. We feel the results are not primarily due to a hemodynamic improvement by means of increased formation of collateral vessels but are due to the fact that physical training and ischemia enable skeletal muscle to adapt to hypoxia by increasing its oxidative capacity and altering its substrate preference. Therefore, an initially conservative approach to acute superficial femoral artery thrombosis is justified if the limb is viable.     

双功能彩色多普勒超声对股浅动脉支架植入术后再狭窄的预测价值

目的通过回顾性分析股浅动脉支架内再狭窄的动脉造影和双功能彩色多普勒超声检查资料,评价双功能彩色多普勒超声对股浅动脉支架内再狭窄的预测价值。方法对接受股浅动脉支架植入治疗的96例患者(共112条下肢)进行双功能彩色多普勒超声检查,记录支架近端3 cm无病变区收缩期峰值流速(Vp)和支架内收缩期峰值流速(PSV),计算PSV与Vp的比值(PSVR)。对下肢缺血症状复发和怀疑存在支架内再狭窄的患者行数字减影血管造影(DSA)检查,并完成双功能彩色多普勒超声与DSA检查资料的配对。应用SPSS 17.0、MEDCALC 11.6.1.0统计学软件,将DSA检查支架内再狭窄率与PSV、PSVR进行直线回归分析和受试者工作特征(ROC)曲线统计学分析,判断PSV、PSVR与支架内再狭窄的关系。结果 PSV(R2=0.83)和PSVR(R~2=0.76)均与DSA检查支架内再狭窄率存在线性相关(P值均<0.001)。ROC曲线显示,当DSA检查支架内再狭窄率>50%时,其PSV>165 cm/s,敏感度为95.5%,特异度为97.8%,阳性预测值为98.4%,阴性预测值为93.7%,ROC曲线下面积(AUC)为0.994;PSVR>1.90,敏感度为90.9%,特异度为1 00.0%,阳性预测值为100.0%,阴性预测值为88.5%,AUC为0.979。当DSA检查支架内再狭窄率>80%时,其PSV>285 cm/s,敏感度为94.1%,特异度为99.0%,阳性预测值为94.1%,阴性预测值为98.9%,AUC为0.980;PSVR>2.7,敏感度为94.1%,特异度为90.5%,阳性预测值为64.0%,阴性预测值为98.9%,AUC为0.973。支架内再狭窄率>50%和>80%时,PSV与PSVR的AUC的差异均无统计学意义(P值均>0.05)。结合PSV>285 cm/s和PSVR>2.7预测支架内再狭窄率>80%,其敏感度为94.1%,特异度为97.9%,阳性预测值为88.9%,阴性预测值为98.9%。结论 PSV和PSVR可有效地预测支架内再狭窄。联合PSV>285 cm/s和PSVR>2.70,对诊断支架内再狭窄率>80%具有更高的可靠性。     

应用冠状动脉旋磨术治疗慢性闭塞性冠状动脉病变

目的：观察冠状动脉旋磨术治疗慢性闭塞性冠状动脉病变的效果。方法：对21支慢性闭塞性冠状动脉（闭塞时间＞1个月）实施冠状动脉旋磨术，包括8例行冠状动脉球囊成行术失败者，TIMI 1级8例，TIMI 0级13例，闭塞病变位于前降支6例，回旋支7例，右冠状动脉8例，结果：13例患者冠状动脉旋磨术成功，TIMI 1级成功率100％，闭塞时间＜3个月者成功率75％，闭塞时间＞3个月者成功率40％，成功者中闭塞时间最长16个月，平均8．12个月，结论：冠状动脉旋磨术治疗慢性闭塞性冠状动脉安全有效。     

药物涂层球囊治疗股浅动脉支架后再狭窄的临床效果研究

目的 探讨药物涂层球囊治疗股浅动脉支架后再狭窄的临床疗效.方法 选取2017年1月至2019年10月本院收治的72例股浅动脉狭窄患者作为研究对象,按照随机数字表法分为对照组与研究组,每组36例.对照组采用普通球囊治疗,研究组采用药物涂层球囊治疗,比较两组临床疗效、靶血管一期通畅率、免于靶病变血运重建率、踝肱指数及并发症发生率.结果 研究组并发症发生率为11.11％,对照组为5.56％,两组比较差异无统计学意义.术后7 d、3个月、6个月,两组踝肱指数比较差异无统计学意义;术后12、24个月,研究组踝肱指数均高于对照组,差异有统计学意义(P<0.05).术后3、6、12、24个月,研究组靶血管一期通畅率、免于靶病变血运重建率均高于对照组,差异具有统计学意义(P<0.05).结论 药物涂层球囊治疗股浅动脉支架后再狭窄疗效显著,能明显改善患者临床症状,值得临床推广应用.     

糖尿病下肢动脉硬化闭塞症患者超声引导下股动脉穿刺置管的效果观察

目的:观察糖尿病下肢动脉硬化闭塞症患者应用超声引导下股动脉穿刺置管的临床应用效果。方法:选取下肢动脉硬化闭塞症糖尿病患者255例,超声引导下经皮穿刺股动脉并留置导管。结果:255例下肢动脉硬化闭塞症糖尿病患者中,一次穿刺成功为246例,占96.47%;穿刺并发症为血肿形成5例,占1.96%;穿刺部位局部皮下淤血4例,占1.57%。结论:糖尿病下肢动脉硬化闭塞症患者应用超声引导下经皮穿刺置管股动脉安全有效。     

肝素包被Wiktor支架植入术15例

0　引言　为验证肝素包被 Wiktor支架 (Medtronic公司 ,简称肝素支架 )预防支架血栓作用 ,评估长期疗效 ,我院自 1997-11/ 1998- 0 1为 12例冠心病患者尝试安装肝素支架 ,现总结报道如下 .1　对象和方法1.1　对象　患者 12 (男 11,女 1)例 ,年龄 (5 6 .3± 9.5 )岁 (40～ 70岁 ) .稳定性心绞痛 1例 ,不稳定性心绞痛 7例 ,近期心梗 (≤ 4wk) 4例 .单支、双支、三支病变各 4,6 ,2例 .1.2　介入资料　靶血管 13支 ,L AD(前降支 ) ,L CX(回旋支 ) ,RCA(右冠 )各 6 ,6 ,1例 .靶病变 14处 ,A,B,C型病变各4,5 ,5处 ,其中 4处病变扭曲 ,4处为…     

Silent myocardial ischaemia in patients with proved coronary artery disease: a comparison of diabetic and non-diabetic patients

OBJECTIVE—To determine whether diabetic patients with coronary artery disease are more likely to experience silent myocardial ischaemia than subjects without diabetes.
SUBJECTS—Patients undergoing coronary angiography at a regional cardiothoracic unit, identified as having diabetes from the local district diabetic register/database.
DESIGN—The coronary angiograms and exercise treadmill tests of 100 diabetic and 100 non-diabetic patients who all had significant coronary artery disease and maximal effort exercise tests were reviewed. Patients were individually matched for age group, gender, severity of coronary artery disease, and indication for treadmill test.
OUTCOME MEASURES—Significant coronary artery disease was defined as a stenosis of greater than 50% diameter in at least one of the major coronary artery segments. Exercise tests were graded as positive if the electrocardiographic (ECG) recording showed planar or downsloping ST segment depression of ⩾1 mm in more than two leads at 80 ms post J-point or if there was a blood pressure fall ⩾10 mm Hg after an initial rise. A negative exercise test was defined as one in which the subject experienced no pain, had no ECG changes after maximal effort and had a normal blood pressure response. Subjects who did not experience any form of typical angina-type pain during a positive exercise test were defined as having an episode of silent ischaemia. Patients with symptomatic ischaemia were those who experienced typical angina-type pain with accompanying ST segment changes. Patients with a negative exercise test were defined as having "undetermined ischaemia". This category included all those without ECG evidence of myocardial ischaemia during the exercise test (with or without accompanying chest pain).
RESULTS—In the diabetic patients, 34% had ECG evidence of silent ischaemia on treadmill testing compared with only 19% of the non-diabetic controls (p<0.02).
CONCLUSIONS—This study shows that diabetic patients with proved coronary artery disease have a higher risk of developing silent myocardial ischaemia during exercise than non-diabetic patients.


     

PTA及血管内支架术治疗创伤后股浅动脉狭窄一例报道

经皮腔内血管成形术（percutaneous transluminal angioplasty，PTA）是指经皮穿刺引入球囊导管、金属内支架等器材对狭窄、闭塞的血管进行扩张等多种微创治疗，使其复通的一种非常规手术疗法。其中单纯用球囊导管扩张治疗称为球囊扩张术，即通常所指的PTA；而应用金属内支架治疗则称作血管内支架术（endovascular stenting）。     

PTA及血管内支架术治疗创伤后股浅动脉狭窄一例报道

经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)是指经皮穿刺引入球囊导管、金属内支架等器材对狭窄、闭塞的血管进行扩张等多种微创治疗,使其复通的一种非常规手术疗法.其中单纯用球囊导管扩张治疗称为球囊扩张术,即通常所指的PTA;而应用金属内支架治疗则称作血管内支架术(endovascular stenting).本文报道一例经皮腔内血管球囊扩张+血管内支架术治疗股浅动脉破裂修补后狭窄的病例.     

颈动脉支架置入术对无症状性颈动脉高度狭窄患者认知功能的影响

目的：探讨颈动脉支架置入术对无症状性颈动脉高度狭窄患者认知功能的影响。方法选择2009年9月至2012年12月期间在该科住院患者156例（狭窄程度大于或等于70％）,行颈动脉支架置入术。在支架置入术前1周内及置入术后3个月采用阿尔茨海默病评估量表认知部分（ADAS‐Cog）、简易智能量表（MMSE）、连线测验（TMTa、TMTb）对患者的认知功能进行评估。结果所有患者均安全、成功的置入颈动脉支架,其中1例患者术后失访。与术前相比,术后3个月患者的认知功能均有所改善,术前术后比较：ADAS‐Cog[（6．60±2．04）分vs．（5．16±1．63）分,P＜0．01],MMSE[（26．32±1．06）分vs．（27．05±1．46）分,P＜0．01],TMTa[（108．94±17．42）分vs．（94．70±20．27）分,P＜0．01],TMTb[（178．65±21．77）分vs．（148．92±23．65）分,P＜0．01],术后3个月内无新发脑梗死。结论颈动脉狭窄可能为认知功能减退的原因之一,颈动脉支架置入术可以改善无症状颈动脉狭窄患者认知功能。     

股骨颈骨折患者使用下肢牵引带的研究进展

股骨颈骨折患者常规行下肢皮肤牵引术,由于牵引套边缘束勒及足跟皮肤持续受压极易发生压疮,既增加患者的痛苦又影响治疗及康复,近来大量的学者进行了相关研究,如牵引带的改良、牵引带加设保护垫及如何提高牵引效果等,使患者足跟压疮的并发症明显下降,治疗及康复工作取得了良好的进展.     

Incidence of thrombosis after implantation of drug-eluting stents in patients with coronary artery disease

Background Randomized clinical trials have demonstrated equivalent safety to bare-metal stents after drug-eluting stents （DES） implantation. However, the DES thrombosis in randomized trials could not be comparable to those observed in clinical practice, frequently including off-label indications. This study sought to assess the incidence of DES thrombosis after implantation of DES in patients with real world coronary artery disease （CAD） in China.
Methods From December 2001 to April 2007, 8190 consecutive patients received the treatment with DES, 5412 patients completed one year follow-up： 2210 with sirolimus-eluting stent Cypher, 1238 with paclitaxel-eluting stent Taxus and 1964 with Chinese sirolimus-eluting stent Firebird, After two years of follow-up, there were 2176 patients （1245 Cypher, 558 Taxus and 373 Firebird）. All patients were treated with aspirin and clopidogrel over at least 9 months.
Results Among 8190 patients, 17 patients had acute stent thrombosis （0.24%）： 7 in the Cypher group, 4 Taxus and 6 Firebird; 23 patients had subacute stent thrombosis： 8 Cypher, 6 Taxus and 9 Firebird. The incidence of acute and subacute thrombosis was 0.49%： 0.50% Cypher, 0.63% Taxus and 0.41% Firebird. The incidence of late thrombosis at one year followup was 0.63%： 0.63% Cypher, 0.88% Taxus and 0.46% Firebird; at two year follow-up the incidence was 0.74%： 0.72% Cypher, 0.90% Taxus and 0.54% Firebird. There was no significant difference among three groups at 1 year and 2 years follow-up.
Conclusion The first generation DES in the treatment of complex lesions are safe and effective if patients are aggressively treated with dual antiplatelet agents.     

血管斑块切除系统治疗股浅动脉病变（2例报告）

目的总结国内首次使用外周血管斑块切除系统的体会。方法对2例股浅动脉短段狭窄闭塞病变患者使用Silver Hawk外周血管斑块切除系统进行斑块切除，通过动脉造影和踝肱指数评估治疗效果。结果2例患者术中狭窄闭塞病变段基本恢复正常管径，随访6个月下肢踝肱指数正常。结论外周血管斑块切除系统对股浅动脉短段病变近期治疗效果理想。     

Long-term outcomes of drug-eluting versus bare-metal stent implantation in patients with chronic total coronary artery occlusions

Background There are limited data on the efficacy of drug-eluting stents （DES） for treatment of chronic total occlusions （CTO）. The aim of the study was to evaluate the long-term clinical outcomes of DES implantation for CTO compared with bare-metal stent （BMS） implantation.
Methods Between June 1995 and December 2006, a total of 1184 patients with successful recanalization of at least one de novo CTO lesion were consecutively registered, including 660 （55.7%） who underwent DES and 524 （44.3%） who underwent BMS implantation. All patients were followed up for up to 5 years for occurrence of major adverse cardiac events （MACE）. Long-term survival rates were estimated with the Kaplan-Meier method.
Results Baseline clinical and angiographic characteristics were comparable between the two groups except that patients in the DES group received longer dual antiplatelet therapy （（7.4±2.5） months vs （1.7±0.8） months, P 〈0.001）. Average follow-up periods were （4.7±0.89） and （3.2±1.3） years for the BMS and DES groups, respectively. There was no significant difference in 5-year survival rates between the two groups （90.3% for DES group vs 89.6% for BMS group, Log-rank P=0.38）, but the 5-year target vessel revascularization （TVR）-free survival rate in the DES group was significantly higher than that in the BMS group （81.6% vs 73.5%, Log-rank P 〈0.001）. The cumulative MACE-free survival in the DES group was also significantly higher than that in the BMS group （80.6% vs 71.5%, Log-rank P〈0.001）. The rates of readmission caused by cardiovascular disease （27.0% vs 37.8%, P 〈0.001） and the need for bypass surgery were significantly lower in the DES group （1.5% vs 3.4%, P 〈0.05）. By multivariable analysis, DES implantation could significantly lower the long-term MACE risk of PCI for CTO patients （HR： 0.492; 95% Cl 0.396-0.656, P 〈0.001）. Left ventricular ejection fraction 〈50% and elderly （〉65 years） were identified as independent predictors of long-term MACE during follow-up.
Conclusion This study demonstrates the long-term （up to 5 years） efficacy of DES for treatment of CTO, which is superior to BMS implantation in reducing the rates of TVR and MACE, as well as the need of re-admission and bypass surgery.