经皮腘下动脉腔内血管成形术初步经验分析

目的观察了解经皮腔内血管成形术(PTA)在治疗下肢动脉闭塞症腘下段病变中的可行性和短期效果。方法选取4例下肢动脉硬化闭塞症患者,对其7支腘下动脉的15处病变进行PTA治疗,观察术中及术后患者的临床和血管造影表现,并对其中3例患者进行短期(<12个月)随访。结果PTA技术成功率60%(9/15),PTA后放置支架6枚;术后1例出现骨筋膜室综合征而截肢;术后6个月的血管通畅率50%(3/6),血管病变复发率38.5%(5/13);1例于术后9个月余截除第一趾。结论在明确病变远侧流出道情况下,经皮腘下动脉腔内血管成形术对于严重下肢缺血的患者具有肯定的近期疗效。     

Percutaneous transluminal angioplasty following endarterectomy

Prior to the introduction of percutaneous transluminal angioplasty (PTA), bypass grafting or endarterectomy was the treatment of choice for aortoiliofemoral atherosclerotic occlusive disease. Currently, PTA is a well-established procedure for the treatment of aortoiliofemoral atherosclerotic occlusive disease. PTA is as effective as, and safer than, surgery in these cases. Percutaneous transluminal angioplasty and endarterectomy cause similar trauma to the arterial wall, i.e., intimal denudation, plaque disruption and splitting, and medial disruption, splitting, and overstretching. Both PTA and endarterectomy heal in a similar manner, i.e., neointima formation and scarring. Both PTA and endarterectomy can be repeated. Therefore, PTA can be performed after endarterectomy or vice versa. Several patients with recurrent occlusive disease after endarterectomy have been safely treated with PTA. Our results obtained with PTA in patients who had a prior endarterectomy are comparable to the results obtained in patients who did not have a prior endarterectomy. No complications have been encountered. A previous endarterectomy does not preclude a subsequent PTA, or vice versa, in patients with recurrent occlusive disease.     

Percutaneous transluminal angioplasty of the abdominal aortic bifurcation

Percutaneous transluminal angioplasty (PTA) of the abdominal aortic bifurcation was performed in three patients with atherosclerotic disease. All three patients had experienced severe claudication on exertion. The dilatations were performed with Gruntzig balloon catheters after determination of a significant pressure gradient (greater than 20 mm Hg) across the stenotic lesions. Follow-up at 9, 12, and 23 months revealed no recurrent symptoms. Balloon dilatation of the distal abdominal aorta is safe and effective and eliminates the risk of impotence that is common after vascular reconstruction.     

20例经皮冠状动脉腔内成形术

目的：总结经皮冠状动脉腔内成形术（ＰＴＣＡ）的经验以求改善ＰＴＣＡ技术，提高临床ＰＴＣＡ的成功率。方法：ＰＴＣＡ按Ｇｒｕｎｔｚｉｇ方法进行。结果：对２０例严重冠状动脉硬化性心脏病患者进行ＰＴ－ＣＡ，共计３０支３９处血管病变中的２６支３５处病变进行了有效扩张，平均扩张次数３．５±２．６次／处，扩张时间６５±２１秒／次，扩张压力每次７．５±２．３ａｔｍ。平均狭窄程度由８７％减轻至１５％，狭窄完全消失的病变有２８处。１例术中发生急性冠状动脉闭塞，经植入支架后恢复正常，未发生其它严重并发症。总成功率１００％。术后心绞痛、心电图缺血性ＳＴＴ改变消失或减轻。结论：ＰＴＣＡ具有创伤小、疗效确切和较安全等优点；植入冠状动脉内支架是处理ＰＴＣＡ所致急性冠状动脉闭塞的有效方法；对于有指征的陈旧性心肌梗塞患者也宜积极采取ＰＴＣＡ的治疗，有助于提高生活质量，改善预后     

支架植入术治疗肾血管性高血压的中远期疗效

目的:评价肾动脉内支架植入术(PTRAS)治疗肾血管性高血压的中远期疗效。方法:对42例肾血管性高血压(动脉粥样硬化性肾动脉狭窄21例,静止性大动脉炎肾动脉狭窄18例,肌纤维发育不良肾动脉狭窄3例),成功的施行PTRAS治疗肾动脉狭窄,采用彩色多普勒超声、CTA、定期门诊检查及肾动脉造影随访12～60月。全部病例均根据临床血压进行疗效评价。结果:支架植入术技术成功率100%。近期疗效(≤3月):42例患者高血压治愈者24例(57.14%)、改善者13例(30.95%)、无效者5例(11.90%)。中期疗效(4～12月):42例患者高血压治愈者17例(40.5%)、改善者19例(45.2%)、无效者6例(14.3%)。远期疗效(≥13月):42例患者高血压治愈者16例(38.1%)、改善者17例(40.5%)、无效者9例(21.4%)。≥3年疗效:24例高血压患者治愈者16例、改善者6例、2例无效。随访中有10例发生支架内再狭窄,行经皮腔内肾动脉成形术(PTRA)后,有6例血压改善。结论:PTRAS治疗肾血管性高血压中远期临床疗效肯定,支架内再次狭窄,大部分病例行PTRA可取得满意的疗效。     

球囊导管成形术加血管内支架治疗Budd-chiari综合征

目的 :探讨球囊导管成形术 (PTA)加放置血管内支架治疗Budd -chiari综合征 (BCS)的价值。方法 :对 12例BCS患者 ,其中下腔静脉闭塞型 8例 ,肝静脉闭塞型 3例 ,混合型 1例 ,先行PTA ,再放置血管内支架。结果 :所有患者均置管成功 ,术后下腔静脉和肝静脉狭窄部直径分别由 1 0 4± 0 .3 8mm增加至 14 5 9± 1 2 5mm ,平均静脉压由 3 0± 6cmH2 O( 1cmH2 O =0 .0 98kPa)降至 15± 1 4cmH2 O。主要症状体征除 1例死亡外 ,其余 11例消失或基本消失 9例 ( 81 8% ) ,明显改善或缓解 2例 ( 18 2 % )。随访 7例无 1例发生再闭塞。结论 :PTA加内支架具有损伤小、疗效显著、再闭塞发生率低等特点 ,因此 ,应作为BCS治疗的首选方法     

血管成形术治疗透析用动静脉内瘘狭窄

目的 探讨血管成形术在治疗血液透析动静脉内瘘狭窄中的作用. 方法 选择2006年7月至2013年2月中国中医科学院西苑医院37例血液透析动静脉内瘘狭窄闭塞的患者进行经皮腔内血管成形术治疗经肱动脉顺行穿刺,行前臂动脉造影检查及动静脉内瘘狭窄血管段球囊扩张血管成形术.结果 37例患者中34例成功进行了血管成形治疗,术后造影显示血管狭窄消失,术后透析血流量大于250ml/min,满足血液透析需求,技术成功率及临床成功率均为91.9％,术后平均随访12.3个月,3、6和12个月初始通畅率分别为94.2％、88.5％和78.3％,术中未出现严重并发症.结论 血管成形术是治疗血液透析动静脉内瘘狭窄的有效方法,甚至可作为治疗血液透析动静脉内瘘狭窄的首选方法.     

Percutaneous transluminal angioplasty in the lower extremities: a 5-year experience

From January 1979 to March 1984, percutaneous transluminal angioplasty (PTA) was used to treat 148 limbs of 135 Mayo Clinic patients with occlusive arterial disease of the lower extremities. The procedure was technically successful in more than 95% of the attempts. The outcome was clinical improvement in 89 limbs and no improvement in 40 limbs; in 19 limbs, PTA was technically successful but the patient was dismissed from the hospital and lost to follow-up before the extent of improvement could be determined. Mean ankle/brachial pressure indices increased after PTA in those with clinical improvement but not in those without improvement. Clinical improvement was less likely to follow PTA in patients with advanced age, diabetes, severe initial symptoms, low ankle/brachial indices, or distal occlusive disease. In patients with improvement after PTA, the mean follow-up period was 33 months; during that time, failure (defined as recurrence of the original symptoms or the need for repeat PTA or operation) occurred at a rate of 6.4% per year. Serious complications occurred after three procedures (2.0%). We conclude that PTA is technically feasible and generally safe for many patients with occlusive arterial disease of the lower limbs.     

Percutaneous transluminal angioplasty improves blood pressure and renal function in renovascular hypertension

Thirty-three patients with renal angiographic evidence of significant renal artery stenosis were referred for percutaneous transluminal angioplasty. The indications were poorly controlled hypertension (n = 13) or hypertension associated with deteriorating renal function (n = 20). Their mean age was 56 (23-73) years (12 males, 21 females). Causes of the renal artery stenosis were fibromuscular dysplasia (n = 8) and atheromatous changes (n = 25). Four patients were excluded, three due to technical failure. Forty-five angioplasties were performed in 29 patients with a mean observation period after angioplasty of 18 (one to 60) months. During this period eight patients (28 per cent) had a diastolic blood pressure of less than 90 mmHg without antihypertensive drugs, a further 15 patients (52 per cent) had improved blood pressure control with a significant reduction in the number and amount of antihypertensive drugs, but six patients (20 per cent) showed no improvement in blood pressure. Hypertension associated with the stenosis of fibromuscular dysplasia responded better to angioplasty than hypertension associated with atheromatous renal artery stenosis. Improvement in renal function was noted in eight patients with no change in 16 patients. Two patients with end-stage renal failure and atheromatous intrarenal vascular disease became dialysis dependent within four weeks of the procedure. One major and four minor complications occurred but there were no deaths related to angioplasty. Together with results from other centres this study indicates that percutaneous transluminal angioplasty should be considered the initial treatment choice for all patients with renovascular hypertension due to fibromuscular dysplasia and atheromatous renal artery stenosis.     

Percutaneous transluminal angioplasty (PTA) in peripheral arterial occlusive disease of the lower extremities

The results of 185 percutaneous transluminal angioplasties (PTA) of the iliac (n = 62) and femoropopliteal segment (n = 123) with a double-lumen balloon catheter (Olbert) are presented. The mean age of the 150 patients was 64 years (range 39 to 91). While there were 87% stenoses and only 13% occlusions of the iliac segment, in the femoropopliteal segment the respective ratios were 46% and 54%. 71% of the patients suffered from intermittent claudication and 29% were severely ischaemic cases (Fontaine stages III and IV). Platelet inhibition was induced by means of acetylsalicylic acid 1 g/day prior to and during the procedure, and afterwards heparin was also administered for 4 days. The primary success rate in the iliac segment of 88.7% (of which 12.9% were classified as a partial success) was identical with that in the femoropopliteal region. Stenoses were successfully treated in 94.6% cases (9.9% being partial successes), occlusions in 79.7% (partial success in 16.2% of these cases). Complications occurred in 8.6% of cases, whereby surgical correction was required in half of these. When the procedure was complicated by major embolization into the distal popliteal artery, this was handled successfully by means of local thrombolytic therapy. Over the follow-up period of up to 21 months reocclusion--or high-grade restenosis--occurred in 26 patients. The cumulative patency rate 1 year after PTA was 92% for the iliac and 70% for the femoropopliteal segment.     

下肢动脉硬化闭塞症的腔内成形治疗

目的探讨下肢动脉硬化闭塞性疾病介入治疗方法的选择和临床疗效观测。方法本组53例73处病变(狭窄性48处,闭塞性25处),采用球囊成形、支架成形、腔内旋切和内膜下血管成形等多种介入手段干预、治疗。结果73处病变:单纯球囊成形10例,辅助支架成形20例,均成功;单纯腔内旋切8例,辅助支架成形的14例(19处自膨式支架,1处弹簧式支架),手术失败1例;单纯内膜下血管成形5例,辅助支架成形的11例,手术失败4例。41例临床症状明显改善,20例症状部分缓解,5例疗效欠佳。4例患者因术后缺血再灌注损伤行切开解压后好转,2例因小腿骨筋膜室综合征行膝关节以下离断术。术后平均随访10.5(2~33)个月,2例术后6个月症状复发未予以进一步治疗,1例术后1年再次介入治疗,余患者疗效稳定。结论下肢动脉硬化闭塞症介入治疗方法多样,针对不同类型的病变采用相应的介入治疗手段,临床疗效安全、可靠。     

Percutaneous transluminal coronary angioplasty and the changing indications for coronary artery bypass grafting for single-vessel coronary artery disease.

Patients with single-vessel coronary artery disease have a good long-term prognosis with either medical or surgical therapy. Because percutaneous transluminal coronary angioplasty has become widely available for treating patients with symptomatic single-vessel coronary artery disease, those who currently undergo coronary artery bypass grafting may be a select group. In this study, we examined the effects of the increasing use of percutaneous transluminal coronary angioplasty on the indications for coronary artery bypass grafting in patients with symptomatic single-vessel coronary artery disease and reviewed the type of procedures performed in such patients at our institution between 1983 and 1988. During this period, 115 patients underwent coronary artery bypass grafting for single-vessel coronary artery disease. The indication for revascularization was angina in 111 patients (88% were in class III or IV, Canadian Cardiovascular Society classification), acute myocardial infarction in 3, and a strongly positive result of an exercise test in 1. The number of surgical revascularization procedures annually for single-vessel coronary artery disease remained consistent throughout the study period. In a comparison of the first 3 years of the study with the last 3 years, the number of patients who underwent coronary artery bypass grafting for restenosis after coronary angioplasty increased, but the number who had surgical revascularization because of failure of coronary angioplasty decreased. In addition, more patients received internal mammary grafts during the second half of the study (42 or 72%) than during the first half (24 or 42%).(ABSTRACT TRUNCATED AT 250 WORDS)     

经皮腔内血管成形术治疗糖尿病患者膝下动脉病变

目的 观察膝下动脉经皮腔内血管成形术在糖尿病性下肢重度缺血的疗效.方法 回顾分析首都医科大学附属北京同仁医院血管外科于2007年2月至2011年5月膝下动脉经皮腔内血管成形术治疗2型糖尿病下肢缺血的74例资料,记录其内科情况、Rutherford分期、介入治疗完成时的流出道SVS评分以及术后30d并发症.随访并通过Kaplan-Meier方法计算一期通畅率、症状缓解率、生存率、保肢率,观察其疗效.结果 入选患者74例,患肢89条.平均年龄(70.5±7.4)岁.吸烟者30例、高脂血症22例、高血压病36例、冠心病20例、肾功能不全12例.Rutherford分期:Ⅲ期29条、Ⅳ期30条、Ⅴ期16条、Ⅵ期14条.术前踝肱指数(ABI)平均0.37(0～0.72).术前胫腓动脉流出道评分平均7.5分(3.5～10分).膝下腔内血管成形术技术成功率92.1%,术后ABI0.78(0.33～1.15)(P<0.01),术后胫腓动脉流出道评分平均6.0分(1.5～10分)(P<0.01).随访患者74例,平均随访时间12个月(术后1～23个月),失访6例,其中死亡3例均死于急性心肌梗死,随访率91.9%.1年生存率94.6%,1年保肢率91.9%.术后1年一期通畅率52.8%,1年时症状缓解率83.4%.结论 膝下动脉经皮腔内血管成形术术后1年的通畅率较低,但症状缓解率明显,有较高的保肢率,使其可以作为糖尿病膝下动脉闭塞治疗的首选,远期疗效还有待进一步观察.