介入联合血管旁路移植术治疗下肢动脉硬化闭塞症

目的总结介入联合血管旁路移植术治疗下肢动脉硬化闭塞症（arteriosclerosis obliterans,ASO）的临床效果。方法采用髂动脉病变段球囊扩张（PTA）及内置支架（stent）联合股→胭→小腿动脉旁路术治疗下肢动脉硬化闭塞症23例。术前均测定影肱比值（ABI）平均为0．24±0．14（0．11—0．48）,并行动脉血管造影（DSA）,依据患者条件选择彩超或CTA。结果行髂动脉病变段球囊扩张及内置支架术23例,股→胭动脉膝上旁路移植13例和行膝下旁路移植2例,左股→右股动脉耻骨上旁路移植5例,膝下胴→小腿动脉旁路移植3例,均取得成功。术后ABI检查为0．71±0．19（0．53～0．89）,临床症状明显改善。随访期为2006年7月-2007年12月,除2例存在静息痛和不同程度间歇性跛行外,其他患者症状完全改善。结论介入联合血管旁路移植术是治疗下肢动脉硬化闭塞症的有效方法,远期效果佳。     

旁路转流术治疗下肢动脉闭塞症104例临床分析

目的 总结104例下肢动脉闭塞症人工血管或自体大隐静脉旁路转流术的治疗经验.方法 回顾性分析1995～2006年对104例下肢动脉闭塞症实施的113次动脉旁路转流术的临床资料,其中腹主-双侧髂股动脉人工血管旁路15例(3例联合实施腰交感神经切断术),腋-双股动脉人工血管旁路4例,髂-股动脉人工血管旁路25 例次,股-腘动脉旁路40例次,股-股动脉人工血管旁路25例次,腘-胫后动脉旁路4例次.结果 10例切口皮缘坏死致愈合延迟,5例术后出现肢体坏疽行截肢术,其余病人术后恢复良好.踝肱指数由术前0.30±0.09增至0.77±0.09(t=3.787,P＜0.01).结论 动脉粥样硬化短段、局限病变以介入方法治疗为首选,长段闭塞或多节段闭塞的病变以手术治疗为主,并应正确选择流入道、流出道及血管代用品.     

手术联合血管腔内成形术治疗多节段下肢动脉硬化闭塞症观察

目的研究并探讨手术联合血管腔内成形术治疗多节段下肢动脉硬化闭塞症的临床效果。方法研究选取我院在2010年10月至2012年8月收治的40例多节段下肢动脉硬化闭塞症患者,所有患者都自愿接受调查和服从所有准则,将患者作为研究对象并对其进行髂动脉球囊扩张和支架植入结合股-腘动脉人工血管转流手术治疗,观察患者在采用该种治疗手术的效果,并将所得到的资料进行分析研究。结果在收治的40例患者中(共40下肢),有22条属于髂内动脉行血管内支架植入,有18条属于单纯性球囊导管扩张。结论对多节段下肢动脉硬化闭塞症患者进行髂动脉球囊扩张和支架植入结合股-腘动脉人工血管转流手术治疗,一方面具有手术创伤比较小,手术较为安全等特点,另一方面具有操作简单,并发症较小等优势,因此该方法值得在临床上推广和使用。     

手术联合血管腔内成形术治疗多节段下肢动脉硬化闭塞症观察

目的研究并探讨手术联合血管腔内成形术治疗多节段下肢动脉硬化闭塞症的临床效果。方法研究选取我院在2010年10月至2012年8月收治的40例多节段下肢动脉硬化闭塞症患者,所有患者都自愿接受调查和服从所有准则,将患者作为研究对象并对其进行髂动脉球囊扩张和支架植入结合股-腘动脉人工血管转流手术治疗,观察患者在采用该种治疗手术的效果,并将所得到的资料进行分析研究。结果在收治的40例患者中(共40下肢),有22条属于髂内动脉行血管内支架植入,有18条属于单纯性球囊导管扩张。结论对多节段下肢动脉硬化闭塞症患者进行髂动脉球囊扩张和支架植入结合股-腘动脉人工血管转流手术治疗,一方面具有手术创伤比较小,手术较为安全等特点,另一方面具有操作简单,并发症较小等优势,因此该方法值得在临床上推广和使用。     

手术联合血管腔内成形术治疗多节段下肢动脉硬化闭塞症观察

目的 研究并探讨手术联合血管腔内成形术治疗多节段下肢动脉硬化闭塞症的临床效果.方法 研究选取我院在2010年10月至2012年8月收治的40例多节段下肢动脉硬化闭塞症患者,所有患者都自愿接受调查和服从所有准则,将患者作为研究对象并对其进行髂动脉球囊扩张和支架植入结合股-腘动脉人工血管转流手术治疗,观察患者在采用该种治疗手术的效果,并将所得到的资料进行分析研究.结果 在收治的40例患者中(共40下肢),有22条属于髂内动脉行血管内支架植入,有18条属于单纯性球囊导管扩张.结论 对多节段下肢动脉硬化闭塞症患者进行髂动脉球囊扩张和支架植入结合股-腘动脉人工血管转流手术治疗,一方面具有手术创伤比较小,手术较为安全等特点,另一方面具有操作简单,并发症较小等优势,因此该方法值得在临床上推广和使用.     

腋-股动脉旁路术治疗主髂动脉闭塞性疾病的疗效分析

目的 探讨腋-股动脉旁路术在治疗主髂动脉闭塞性疾病中的意义.方法 回顾性分析采用腋-股动脉旁路术治疗的35例主髂动脉闭塞性疾病患者,其中有间歇性跛者5例,下肢静息痛11例,合并溃疡或坏疽19例.闭塞原因包括动脉硬化闭塞症29例、血栓形成5例、主动脉夹层1例.术式为腋-双股动脉旁路术19例,腋-单侧股动脉旁路术16例,使用的旁路移植血管均为聚四氟乙烯(Gore-Tex)人工血管.结果 本组病例围手术期未发生死亡,术后患肢间歇性跛行或静息痛消失,皮肤温度、颜色明显改善.远期随访时间3～80个月,总的术后1、3、5年移植血管的通畅率分别为:93％、87％、81％.结论 腋-股动脉旁路术具有侵袭性小,疗效确切等特点,是治疗主髂动脉闭塞性疾病的有效方法之一.     

注射毒品致感染性假性股动脉瘤破裂19例外科治疗

目的 探讨注射毒品致感染性假性股动脉瘤破裂的外科治疗方法.方法 回顾分析19例注射毒品致感染性假性股动脉瘤破裂患者的临床资料,术前应用彩超或下肢血管造影诊断;8例采用人工血管行旁路髂外动脉和股浅动脉端端吻合术,11例行单纯瘤体两端股动脉结扎术.结果 全部病例手术成功,无继发肢体坏死;血管移植者术后复查彩色多普勒超声显示移植血管通畅.结论 瘤体切除+人工血管移植仍是治疗注射毒品所致假性股动脉瘤的理想方案;但在无条件行血管移植时,瘤体切除+股动脉结扎术是治疗的有效方法之一;不提倡行破裂瘤体修补术.     

人工血管旁路架桥术治疗下肢动脉缺血的临床分析

目的　为提高人工血管旁路架桥手术治疗下肢严重动脉缺血的临床效果 ,对采用人工血管动脉旁路架桥治疗的下肢严重动脉缺血 32例进行分析。方法　 1996年 1月 - 2 0 0 1年 6月间全组男 2 4例 ,女 8例 ,年龄 5 8 6± 15 1岁。动脉闭塞分别位于肾下腹主动脉、髂动脉、股动脉或股 -动脉 ,行人工血管旁路架桥术。结果　经术后平均 2年 7个月的随防 ,截肢率为 12 5 % ,阻塞率为 18 7% ,通畅率为 81 2 %。结论　下肢动脉闭塞时 ,采用人工血管行动脉旁路架桥术是重建患肢血液循环通道的有效方法 ,动脉造影是选择正确重要手术方式的必要保证。     

人造血管旁路在下肢动脉硬化长段闭塞治疗中应用

目的:探讨人工血管在下肢动脉硬化闭塞症的治疗临床经验?方法:回顾性分析2006年6月~2011年6月收治的27例(27条肢体)下肢动脉硬化闭塞症患者实施人造血管动脉重建术资料?结果:术后25条下肢疼痛消失,2例肢体溃疡愈合,疼痛减轻,随访1~3年,2例术后6个月人工血管血栓形成,无死亡病例?结论:人造血管旁路术是治疗主髂?股腘动脉长段闭塞性疾病的主要治疗方法?     

缺血肢体血管旁路治疗的探讨

目的 探讨提高血管旁路转流术治疗肾动脉平面以下动脉缺血的临床效果及途径.方法 对应用人工血管和自体大隐静脉行旁路移植术治疗下肢动脉缺血的17例患者进行总结,分别于肾动脉水平以下的腹主动脉至双髂总动脉、腹主动脉至双髂外动脉、髂总动脉至腘动脉、股总动脉至腘动脉上段、股总动脉至腘动脉下段、腘动脉与胫后动脉行架桥术.结果 其中行大隐静脉架桥术的5例患者血管全部通畅,股三角淋巴瘘1例;行人工血管架桥术的12例患者中,伤口液化5例,人工血管外露并阻塞1例,隐神经皮支损伤1例.结论 腹主动脉、双髂动脉或双股动脉闭塞只能采用人工血管架桥术治疗;股总动脉以下股浅动脉以及腘动脉闭塞,人工血管和自身血管性架桥均可应用;而腘动脉下段及膝关节以下的动脉闭塞时,采用自体大隐静脉架桥;动脉造影是正确选择血管重建方式的可靠保证.     

COMBINED INTRAOPERATIVE ILIAC ARTERY STENTS AND FEMORO-POPLITEAL BYPASS FOR MULTILEVEL ATHEROSCLEROTIC OCCLUSIVE DISEASE

Objective. To review our preliminary experience and evaluate our early results of a combined intraopemtive iliac angioplasty and stenting with infrainguinal revascularization in multilevel atherosclerotic occlusive disease. Methods. From July 1999 to April 2000, intraoperative iliac angiOplasty and stenting combined with simultaneous femoro-pepliteal bypass were pedormed on 12 lower extremities of 10 patients suffering from multilevel athemsclemtic occlusive disease. There were 8 men and 2 women, average 72 years. The indicationsf or procedures included disabling claudication in 3 and rest pain in 7 patients. Results. Eleven iliac angioplasty and stem procedures combined with simultaneous 9 femoro-popliteal by-pass and 3 femoro-femoral-popliteal bypass were performed in 12 limbs of 10 patients. Angioplasty and stem placement was technically successful in all patients. One contralateral femoral-popliteal bypass was failure after femoro-femoral-popliteal bypass. There were no additional instances of procedural or postoperative morbidity or mortality. Mean follow-up was 5 months (range 1 -10 months). During the follow-up period, one femoro-infrapoplitealgraft became occluded after 7 months and above-knee amputation was required. The cumulative primary patencyrate of stented iliac arteries, femoro-femoral bypass grafts and femoro-popliteal bypass grafts were 100% (11/11), 100% (3/3) and 90. 9% (10/11) in the follow-up period, respectivdy. The amputation rate was 8. 3%(1/12). Conclusions. Intraoperative iliac artery PTA and stent placement can be safely and effectively pedormed simultaneously with infrainguinal revascularization for multilevel atherosclerotic occlusive disease by skilled vascular surgeon, using a portable C ann fluoroscopy in the operating room. Furthermore, iliac artery PTA and stenting was valuable adjunct to distal bypass either to improve inflow and outflow, or to reduce the extent of traditionalsurgical intervention, and also, any angioplasty and stenting-related complications can be immediately corrected as well.     

股腘动脉搭桥术治疗下肢动脉硬化闭塞症(附39例报告)

本文报告1985～1993年期间作者所作股腘动脉搭桥术治疗下肢股腘动脉粥样硬化闭塞症39例的临床疗效,经术后1月～8年的随访,有效率达73％,肢体存活卑达92％。本手术操作简单,不需特殊设备条件,手术本身可恢复动脉的生理状态,手术疗效良好,故值得推广。作者认为,凡有手术适应症者,应争取尽早作股胭动脉搭桥手术,以小切口法自体大隐静脉移植为首选方法。     

Coronary angioplasty and surgery for coronary artery disease.

Heart disease remains the most common cause of morbidity and mortality in the United States. During the 1970s until the early 1980s, patients with angina pectoris refractory to medical therapy could only consider bypass surgery to relieve their symptoms. Beginning in the early 1980s, coronary balloon angioplasty became an alternative to bypass surgery in those with single vessel coronary artery disease and failure to medical therapy. In the mid-1980s, patients with multi-vessel coronary artery disease also were seen to benefit from balloon angioplasty. Now in the 1990s, balloon angioplasty's success is being compared to coronary bypass with prospective randomized trials. While balloon angioplasty has become relatively easy to perform due to advances in balloon, wire, and guiding catheter technology, many new interventional devices such as atherectomy and laser, are now available. The explosion in technology reflects our inability to prevent atherosclerotic disease and also reveals that while we can improve a patient's lifestyle and in some situations improve mortality rate, atherosclerotic disease remains a disease for which we have no cure.     

大动脉粥样硬化型缺血性脑血管病的搭桥手术策略

目的探讨颞浅动脉-角回动脉搭桥术（STA—AAGbypass）治疗大动脉粥样硬化型缺血性脑血管病的策略。方法回顾性分析2010年1月～2013年6月9例实施颞浅动脉-角回动脉搭桥术的大动脉粥样硬化型缺血性脑血管病患者的资料。包括术前及术后数字减影血管造影（DSA）显示的脑血管情况、计算机断层扫描灌注成像（CTP）显示的脑血流动力学情况、术中所见、随访结果。结果术前DSA显示颈内动脉和（或）大脑中动脉粥样硬化性重度狭窄和（或）闭塞,后循环和（或）颈外动脉和（或）对侧前循环部分代偿,术中多普勒检测颞浅动脉-角回动脉吻合处血流通畅。术后DSA示颞浅动脉-角回动脉吻合通畅,CTP各项参数较术前明显改善。随访3～20个月,无新发脑缺血事件及死亡。结论颞浅动脉-角回动脉搭桥术是治疗大动脉粥样硬化型缺血性脑血管病的有效方法．术前及术后需DSA全面评估颅内外血管情况及CTP评估脑血流动力学情况,可取得良好效果。     

介入治疗慢性动脉粥样硬化下肢单一闭塞性疾病的效果评价

目的：探讨介入治疗慢性动脉粥样硬化下肢单一闭塞性疾病的疗效以及影响因素。方法：选取慢性动脉粥样硬化下肢单一闭塞性疾病患者56例,按闭塞段分为腹主-髂动脉型17例、髂-股动脉型18例和股腘膝下动脉型21例。应用导管、导丝相配合钝性分离微夹层介入技术行闭塞管腔开通后球囊扩张,出现夹层行支架植入术。结果：经介入治疗后闭塞段开通46例(82.1%）,闭塞段未开通症状无改善6例(10.7%）,症状较术前加重4例(7.1%）。其中腹主-髂动脉型开通率（16例,94.1%）与髂-股动脉型开通率（16例,88.9%）比较差异无统计学意义（P>0.05）,腹主-髂动脉型开通率高于股腘膝下动脉型开通率（14例,66.6%）（P<0.05）。闭塞动脉长度在5～10 cm的患者,腹主-髂动脉型开通率（9例,52.9%）和髂-股动脉型开通率（10例,55.5%）均高于股腘膝下动脉型开通率（7例,33.3%）（P<0.05）,而前两型比较差异无统计学意义（P>0.05）。股腘膝下动脉型未开通患者（7例,33.3%）闭塞两端血管侧支代偿血管（≥3支）总数(35支,平均5.00支)多于开通患者（14例,71.4%）侧支代偿血管总数(19支,平均1.36支)（P<0.05）。结论：介入治疗慢性动脉粥样硬化下肢闭塞性疾病安全有效,下肢动脉闭塞位置、闭塞动脉长度和侧支循环建立丰富程度对开通闭塞段有一定影响。     

老年动脉粥样硬化性肾脏病的临床分析及支架置入治疗的效果评价

目的：探讨老年动脉粥样硬化性肾脏病临床特点，评价经皮肾动脉腔内成形及支架置入术对其的治疗效果。方法：回顾性研究我院1999年10月～2003年10月4年间经肾动脉造影确诊的所有38例老年动脉粥样硬化性肾脏病患者，对其临床特点进行总结分析；随访18例经过PTRAS治疗的疗效。结果：老年动脉粥样硬化性肾脏病患者多数伴随有高血压病、冠心病、高脂血症、糖尿病、周围血管病变等危险因素。临床上主要表现为血压升高、肾功能减退等。PTRAS安全性较高，能够改善老年动脉粥样硬化性肾脏病患者的症状，有效降低血压，延缓肾功能恶化。     

下肢动脉硬化闭塞症的多层螺旋CTA的诊断与介入治疗

目的探讨下肢动脉硬化性闭塞症CTA的诊断与介入治疗的临床经验。方法术前采用CTA初步诊断后采用介入技术治疗下肢动脉硬化闭塞症患者18例（20条肢体）。结果20条肢体均成功进行球囊扩张或球囊扩张加支架置入,1例治疗效果欠佳而行截肢治疗,另1例股动脉支架5月后再次出现支架远端狭窄而再次置入支架。所有病例随访6～12月,患者临床症状明显改善。结论介入治疗是治疗下肢动脉硬化性闭塞症的安全、有效方法。     

超声消融在治疗下肢动脉完全闭塞性病变中的应用

目的　评价超声消融治疗下肢动脉硬化性完全闭塞性病变的临床疗效和安全性。方法　对 39例下肢动脉硬化性完全闭塞患者 ,在数字减影动脉造影 (DSA)下采用经皮穿刺方法行血管腔内超声消融 (美国 ,ENHANCEDACOLYSIS ,ANGIOSONICS)治疗 ,观察血管再通、临床疗效和相关并发症情况。结果　经过平均 115 7s± 376s超声消融治疗后 ,管腔再通率 97.4 % (38/ 39) ,平均残余狭窄为 32 %± 11% ,技术成功率 (残余狭窄 <5 0 % )为 82 .1% (32 / 39)。 38例开通者临床症状有不同程度的改善。 2 4h、30d、90d和 180d的管腔通畅率分别为 10 0 % ,94 .7% ,89.5 %和 81.6 %。超声消融相关的并发症有血红蛋白尿 9例 ,远端栓塞 1例。结论　超声消融是治疗下肢动脉硬化性完全闭塞性病变的一种安全有效方法。     

All-trans retinoic acid reduces intimal thickening after balloon angioplasty in atherosclerotic rabbits

Ｐｅｒｃｕｔａｎｅｏｕｓｔｒａｎｓｌｕｍｉｎａｌｂａｌｏｏｎａｎｇｉｏｐｌａｓｔｙ（ＰＴＣＡ）ｈａｓｂｅｃｏｍｅａｗｅｌｅｓｔａｂｌｉｓｈｅｄｔｈｅｒａｐｙｉｎｔｈｅｍａｎａｇｅｍｅｎｔｏｆｃｏｒｏｎａｒｙａｒｔｅｒｙｄｉｓｅａｓｅ．Ｈｏｗｅｖｅｒ...     

Surgical treatment of brachiocephalic vessel involvement in Takayasu’s arteritis

Background Takayasu＇s arteritis （TA） is a chronic idiopathic inflammatory disease that affects large and medium size arteries. The brachiocephalic trunk is the most frequently involved site in TA, and multi-vessel lesions are common. Surgical treatment includes vessel reconstruction surgery and percutaneous transluminal angioplasty （PTA）. Herein, we report our preliminary experience with surgical treatment of cerebral ischemia caused by cervical arterial lesions due to TA.Methods From January 2000 to December 2007, 38 patients with cerebral ischemia caused by cervical arterial occlusive lesions due to TA were treated surgically. There were three males and 35 females, with an age range of 15-42 years （mean 26.5 years）. All patients had operative repairs undertaken. Twenty eight patients received bypass operation and 10 patients received percutaneous transluminal angioplasty. One case with coronary stenosis received coronary artery bypass simultaneously. Patients were followed up for 11 months to eight years.Results There were no peri-operative deaths in cerebrovascular reconstruction patients. Symptoms of cerebral ischemia were improved or cured in 25 of 38 patients. There was a low incidence of cerebral reperfusion syndrome. Two patients died at five and seven years after surgery due to heart failure. Another 8 patients （20%） required further surgery for stenosis （5 patients） or anastomotic aneurysms （3 patients）. Percutaneous transluminal angioplasty was performed successfully for treatment of aortic and renal lesions. Repeated angioplasty for revascularization was performed in six PTA cases with restenosis after 5-24 months.Conclusions When cerebral perfusion has potential to be affected by TA, a definitive corrective procedure is advised when the patient is relatively stable. Although the recurrence rate is very high, percutaneous transluminal angioplasty is the first choice procedure. Bypass operation is optimal for brachiocephalic-vessel involvement in TA. Cerebral reperfusion syndrome can be avoided by careful selection of the operation method and improved post-operative treatment.