急性肢体动脉栓塞87例的诊断及治疗

目的 探讨急性肢体动脉栓塞的诊断和Fogarty导管取栓术的方法和疗效.方法 回顾性分析了87例(89条患肢)诊断为急性肢体动脉栓塞行Fogarty导管取栓治疗患者的临床资料.结果 89条患肢均根据病史、临床症状、体征和多普勒超声确诊,术前均未行肢体造影检查.所有病例均经手术证实.全组治愈78条(87.6%),患肢血供保持良好;好转4条(4.5%),未缺血坏死或截肢;截肢5条(5.6%);2例患者(2.3%)死亡.发病后48h内入院的66例(68条患肢)均治愈(治愈率100%);48h以后入院21例(21条患肢)中,10例(47.6%)治愈,4例(19.0%)好转,5例(23.8%)患肢坏死、截肢,2例(9.6%)患者死亡.结论 为防止误诊,对疑有肢体动脉栓塞者应施行超声多普勒检查;Fogarty导管取栓术是治疗急性肢体动脉栓塞的有效方法;一经确诊急性肢体动脉栓塞,应尽早手术取栓,以减少肢体坏死的危险.     

腔内治疗原发性主动脉血栓10例

目的 探讨原发性主动脉血栓腔内治疗方法,评价其临床疗效。方法 回顾性分析2018年8月至2022年4月收治的10例原发性主动脉血栓患者临床资料。术前CTA检查明确主动脉血栓分型并进行抗凝治疗。对Ⅱ型病变行全身麻醉下支架植入术,Ⅳ型和Ⅲ+Ⅳ型病变行局部麻醉下取栓或支架植入术。采用双股动脉切开或穿刺入路,术中应用Fogarty球囊或Wallstent支架半释放技术预防动脉远端栓塞。周围血管栓塞治疗中仅对下肢动脉、肠系膜上动脉栓塞患者行腔内治疗,其余部位抗凝治疗。取出的血栓行病理学检查。术后继续抗凝治疗。术后1、3、6、12个月随访主动脉CTA及下肢动脉彩色超声,12个月后电话随访。结果 血栓分型Ⅳ型5例,Ⅲ+Ⅳ型2例,Ⅱb型1例,Ⅱa+Ⅱb型2例。取栓4例,直接裸支架治疗2例,直接覆膜支架治疗4例。4例取栓手术应用Fogarty球囊保护,术中未发生血栓异位栓塞;支架植入患者中2例行Wallstent支架保护,其中1例成功抓捕脱落的血栓。周围血管栓塞病变保守治疗4例,腔内手术6例,其中2例髂动脉支架植入,Fogarty球囊取栓3例（2例复发,共5次手术）,大腔导管取栓1例。术后随访1～43个...     

18例LEAE的腔内介入治疗体会

目的:评价腔内介入治疗下肢动脉栓塞(LEAE)的临床疗效和安全性.方法:回顾性分析18例LEAE患者的临床资料,总结LEAE的腔内介入治疗方法及疗效.结果:18例Seldinger穿刺留置导管抽吸出血栓,单纯导管抽栓治疗11例,导管抽栓+尿激酶溶栓治疗4例,导管抽栓+球囊扩张治疗2例,导管抽栓+支架治疗1例.18例患者均顺利开通栓塞动脉,但4例抽栓后破碎的小栓子脱落栓塞远端血管或远端血管血栓形成,采用抽栓联合尿激酶溶栓治疗后,4例完全开通栓塞的远端血管,2例部分开通栓塞远端血管,2例溶栓后远端血管仍不能开通,但侧支循环较前明显增多.随访5.2±5.3个月,15例患者下肢缺血症状完全消失,2例患者栓塞侧足部皮温降低、肤色苍白、末梢血运差,1例截肢治疗.结论:腔内介入治疗下肢动脉栓塞具有微创、简便、安全的特点,可降低患肢缺血、坏死的发生率,疗效明显.     

肝动脉栓塞化疗联合CT导向射频消融术治疗中、晚期肝癌的评价

目的 探讨肝动脉栓塞化疗联合CT导向下的射频消融治疗中、晚期原发性肝癌的疗效。方法 85例中、晚期原发性肝癌患者按单双日法分组原则分为A、B2组。A组：经导管肝动脉栓塞化疗组(TACE组)，共43例；B组：肝动脉栓塞化疗联合CT导向下的射频消融治疗组(联合治疗组)，共42例。结果 TACE组的完全坏死率、初次复发率及1年存活率分别20．93％、39．53％和79．07％；而联合治疗组分别为92．86％、9．53％和97．62％。两组间完全坏死率、初次复发率及1年生存率的差异皆有显著性意义(其相应P值分别为0．001，0．004，0．009)。结论 肝动脉栓塞化疗联合CT导向下的射频消融治疗效果明显优于单纯栓塞化疗。     

双点穿刺阻流取栓与单纯导管吸栓治疗急性下肢动脉栓塞的对比研究

目的探讨、比较单纯导管吸栓法和双点穿刺阻流取栓法治疗下肢动脉急性栓塞的疗效;评价双点穿刺阻流取栓法的治疗价值。方法总结和分析2004年1月-2007年4月收治的79例急性下肢动脉栓塞患者的临床资料:其中单纯导管吸栓法治疗56例,经皮双点穿刺阻流取栓法治疗23例。结果79例下肢动脉急性栓塞患者均采用介入方法成功去除栓子,开通动脉。单纯导管吸栓法治疗组术后截肢(趾)率19.6%(11/56),病死率5.4%(3/56);双点穿刺阻流取栓法治疗组截肢(趾)率8.7%(2/23),病死率4.3%(1/23)。结论经皮双点穿刺阻流取栓术治疗下肢动脉急性栓塞,是一种简便有效的方法,与传统的单纯吸栓术相比,病死率差别无统计学意义,但截肢(趾)率明显下降,且术后恢复快,总体花费少。     

肝动脉栓塞化疗联合微波凝固治疗中晚期肝癌的评价

目的：探讨动脉栓塞化疗(TACE)联合超声引导下经皮微波凝固治疗(MCT)对中晚期肝癌的疗效。方法：65例中晚期原发性肝癌患者按单双日分组原则分为A、B2组。A组：经导管肝动脉栓塞化疗组(TACE组)，共34例；B组：肝动脉栓塞化疗联合超声引导下经皮微波凝固治疗组(联合治疗组)，共31例。结果：TACE组完全坏死率，初次复发率及一年存活率分别为20．59％，32．35％和70．59％；而联合治疗组分别为87．10％，6．45％和96．77％％。两组间完全坏死率，初次复发率及一年存活率的差异皆有显著性差异(其相应的P值均小于0．01)。结论：肝动脉栓塞化疗联合超声引导下经皮微波凝固治疗效果优于单纯栓塞化疗。     

军训致急性下肢深静脉血栓的微创治疗

目的 探讨多种介入方法 相互配合对军训致急性下肢深静脉血栓(DVT)的疗效.方法 对军训致25例急性DVT患者均行Fogarty导管取栓术.其中单纯取栓3例;取栓联合球囊导管血管成形6例;血管成形联合血管腔内超声消融11例;血管成形和(或)血管腔内超声消融联合支架置入5例.对其疗效进行总结. 结果 髂股段静脉完全开通24例,术中造影示管腔直径≥71%;左髂总静脉开口未能开通1例.25例均行术后随访,平均时间34个月.其中24例完全恢复正常或基本正常,可从事正常军事训练;1例髂静脉未开通者训练后仍感肢体肿胀. 结论 多种外科介入技术相互配合可明显提高军训致DVT的疗效.     

肠系膜上动脉栓塞的导管取栓溶栓治疗

目的 评价导管取栓溶栓治疗肠系膜上动脉栓塞的疗效.资料与方法 急性肠系膜上动脉栓塞11例患者(男7例,女4例,年龄61～81岁,风湿性心脏病并房颤7例,心肌梗死4例,合并小脑梗死1例,下肢动脉栓塞2例)采用6 F导引导管、5 F导管、颈动脉保护伞取栓导管溶栓术.结果 11例患者均成功取出血栓,取栓溶栓后血管复通,2例患者开腹探查,1例切除坏死肠管,1例未见肠管坏死,无治疗相关并发症.结论 导管取栓溶栓治疗肠系膜上动脉栓塞操作简便,能迅速恢复肠管血运,提高了临床治愈率.     

下肢动脉血栓栓塞的介入治疗

下肢动脉血栓栓塞常见，起病突然，发展迅速，主要表现5“P”征，若处理不当，可造成患肢坏疽，甚至截肢，给患者的身心健康造成极大的影响。以往采用手术取栓或静脉溶栓，并发症多，效果不满意。我院对8例下肢动脉血栓栓塞患者采用动脉插管经导管滴注尿激酶等溶栓药物溶栓治疗，全部成功，且无严重并发症，值得推广，现报道如下。     

慢性血管内血栓物理性治疗的疗效及影响因素

目的 探讨物理性血管内血栓去除／开通治疗慢性血栓的可行性，分析疗效及影响因素。资料与方法 本组32例患者均经MRA、血管超声及造影证实，其中17例患慢性心衰和／或血管性疾病，15例为重度糖尿病。血栓位于髂动脉13例(左侧6例，右侧4例，双侧3例)，股动脉6例，胭动脉3例，髂静脉9例(左侧6例，右侧3例)，门静脉1例。血栓的长度为3—8cm，直径为5-10mm。9例髂静脉血栓患者物理性治疗前先行放置下腔静脉滤过器。射频消融(ATD)治疗9例(静脉7例)，经皮电动网篮(PTD))2例(门静脉)，流变溶栓(Oasis)3例(动脉2例，静脉1例)，内支架直接开通18例(均为动脉)。所有患者在治疗过程中采用50万U的尿激酶通过导管内直接溶栓。物理性血栓切除后如造影证实血管狭窄者，狭窄部行血管内支架放置。术后治疗包括内科溶栓、肝素抗凝和改善微循环等药物治疗。每2个月做血管超声或CT血管重建随访及临床症状随访。结果 30例(93．8％)成功进行了物理性血栓去除和／或开通，1例门脉血栓者失败，1例股动脉血栓患者同时行ATD和Oasis失败后行外科切开取栓。29例(90．6％)临床症状在1个月内明显改善和消失。物理性治疗后3、6、12个月，血管超声随访累计血管通畅率分别为100％、85．4％和73．2％；同时血流速度恢复正常和明显改善者分别为76．5％、65．4％和印．1％。结论 腔内物理性血栓去除／开通是治疗慢性血管内血栓的有效方法，疗效直接肯定，长期疗效有待于进一步随访。     

两点入路血管支架修复钝性腘动脉损伤

目的 探讨患侧股动脉及胫后动脉两点入路血管支架技术修复钝性腘动脉损伤的临床疗效.方法 回顾性分析2011年3月至2015年3月采用两点入路血管支架技术修复11例钝性腘动脉损伤患者临床资料.术中先顺行穿刺患侧股动脉并造影评估动脉损伤情况,捻转导丝通过损伤段失败即刻穿刺胫后动脉并送入4F单弯导管和圈套器,采用导丝抓捕技术将损伤段导丝捕捉住,使其通过损伤段,并建立工作轨道,经导丝植入血管支架修复损伤动脉;对远端流出道血栓阻塞用6F导引导管抽吸动脉远端血栓,对肢体末梢动脉血栓予动脉内留置导管小剂量尿激酶溶栓治疗.结果 手术成功率100％.动脉造影显示动脉部分断裂7例,完全断裂4例,共植入支架16枚.无围手术期死亡及手术相关并发症.术后随访13～24个月,平均(18.7±3.8)个月,2例出现支架内血栓形成,经溶栓治疗后血流恢复;3例支架腔内狭窄＞70％,给予球囊扩张治疗后血流恢复通畅;6例支架腔内狭窄＜30％,未作特殊处理.随访期未发现支架断裂、变形、移位,无截肢患者.结论 两点入路血管支架修复钝性腘动脉损伤可减少手术时间,快速恢复受损动脉血流,减少肢体缺血时间,近期临床效果显著.     

Hybrid Therapy in Patients with Complex Peripheral Multifocal Steno-obstructive Vascular Disease: Two-Year Results

Purpose To report the 2-year results after hybrid (combined surgical–endovascular) therapy in patients with complex peripheral multifocal steno-obstructive vascular disease. Methods From September 2001 through April 2003, 47 combined surgical–endovascular procedures were performed in a single session in 44 patients with peripheral occlusive artery disease. Although the common femoral artery is usually treated with open surgery, endoluminal procedures were performed upward in 23 patients (group A), distally in 18 patients (group B), and both upward and downward of the area treated with open surgery in 3 patients (group C). Patients underwent clinical assessment and color duplex ultrasonography examination at 1, 3, 6, 12, 18, and 24 months after the procedure. Results The technical success rate was 100%. Two patients died, at 2 and 19 months after treatment, respectively, both from myocardial infarction. Primary and primary-assisted patency rates were 86.2% and 90.8% at 6 months and 79.1% and 86.1% at 24 months, respectively. Thirty-three patients remained free of symptoms, without any secondary interventions, which corresponded to a primary patency rate of 78.6% (33 of 42). Conclusion Combined therapy simplifies and allows the one-step treatment of patients with complex peripheral multifocal steno-obstructive vascular disease that has indications for revascularization, and it provides excellent long-term patency rates.     

Distal venous arterialization for lower limb salvage: angiographic appearances and interventional procedures.

Approximately 14%-20% of patients with critical lower limb ischemia are unsuited for distal arterial reconstruction and face major distal amputation. Distal venous arterialization is a unique procedure in which the venous bed is used as an alternative conduit for perfusion of peripheral tissues. Eighteen patients with stage IV Fontaine critical lower limb ischemia underwent venous arterialization. Preoperative angiographic findings confirmed the absence of any below-knee continuous arterial vessels. The most distal satisfactory artery was used for proximal bypass anastomosis, and venous valves were destroyed with Parsonnet probes, cutting balloons, Fogarty catheters, and valvulotomes under radiologic guidance. All patients underwent intra- and postoperative angiography of the venous grafts and the distal venous bed. Primary and secondary graft patencies were 66% and 72%, respectively, at a mean follow-up of 25 months. The limb salvage rate was 83% overall and 75% at 2-year follow-up. Vascular imaging is essential in selecting and following up patients and in determining the appropriate intraoperative procedure.     

Catheter-directed thrombolytic therapy in peripheral artery occlusions: combining reteplase and abciximab

OBJECTIVE: The goal of this study was to assess the safety and efficacy of combination therapy consisting of the third-generation plasminogen activator reteplase and the glycoproteins IIb and IIIa platelet receptor antagonist abciximab for thrombolysis in peripheral artery occlusive disease. This two-center experience focused on immediate thrombolytic success, thrombolysis time, complication rate, and 30-day patency rate. SUBJECTS AND METHODS: Fifty patients with arterial occlusive disease (age range, 40-96 years; mean age, 69 years) were prospectively enrolled at two centers. Eighteen patients (36%) had native artery thromboses, and 32 patients (64%) had graft thromboses. Catheter-directed intraarterial thrombolytic infusion of reteplase (average dose, 0.51 U/hr; range, 0.25-1 U/hr) was combined with IV infusion of abciximab (bolus, 0.25 mg/kg of body weight; 12-hr infusion, 0.125 microg/kg of body weight per minute). Nontherapeutic heparin (100-400 U/hr) was given intraarterially during the thrombolytic infusion. RESULTS: Complete thrombolysis was achieved in 89% of the patients with native artery occlusions and 94% of the patients with graft occlusions for an overall rate of 92%. The average thrombolysis time was 20.7 hr (range, 4-41 hr) with a mean reteplase dose of 12.1 U (range, 2-23 U). Major hematoma occurred in 12% of the patients, with an average blood transfusion of 3.1 U of packed RBC (range, 1-11 U), and correlated to increased thrombolysis time and dose. No intracranial hemorrhage occurred. The 30-day primary patency rate was 92%. Two patients (4%) underwent amputation, including one major amputation (2%), within 30 days of thrombolysis. CONCLUSION: The combination of reteplase and abciximab in catheter-directed arterial thrombolysis is feasible and effective. Results of this combination therapy suggest acceptable thrombolysis times and doses with tolerable complication rates. Which patient group might benefit the most from combination therapy and the long-term results of combination therapy still need to be determined.     

Fogarty catheter complication treated with angiographic techniques: New use for balloon occlusion catheter

Fogarty catheter embolectomy is occasionally associated with complications, including intimal dissection and thrombosis. We report a case of this complication in the iliac artery treated angiographically by thrombectomy with a balloon occlusion catheter.     

Venöse Interventionen – Teil 1: Interventionstechniken und Thrombosen der Bein- und Beckenvenen

Venous thrombosis is one of the most common vascular diseases. Without treatment, pulmonary embolism is a potentially life-threatening complication. Long-term complications are chronic venous insufficiency and post-thrombotic syndrome. Medical anticoagulation is currently the standard therapy, since it prevents appositional thrombus growth although it usually can not prevent the development of post-thrombotic syndrome. The structure of the thrombotic material often leads to partial recanalisation with residual stenosis. Early and sufficient systemic thrombolysis with adequate concentration may achieve disintegration of the thrombus and preservation of venous valve function. Supplementary to conservative therapy, local catheter thrombolysis is possible even in cases with contraindications for a systemic thrombolysis therapy. Additional interventional techniques reduce the required concentration of the thrombolytic. Venous stenosis can be treated by balloon angioplasty and stent implantation. This article reviews the different percutaneous treatment options as well as their application and usefulness in thrombosis of the lower torso.     

下肢动脉硬化致膝下缺血介入治疗的策略及临床意义

目的 探讨下肢动脉动脉硬化致膝下缺血腔内介入治疗的策略及临床意义.方法 回顾性分析了下肢动脉狭窄闭塞血管内介入治疗患者97例,其中单纯膝下动脉(胫前、胫后动脉)狭窄、闭塞11例,膝上动脉(主髂动脉、股腘动脉)狭窄、闭塞伴有膝下动脉狭窄、闭塞24例.结果 35例患者,成功治疗31例,膝下缺血症状明显改善,取得满意的治疗效果;4例治疗未成功,1例高位截肢,3例足趾截肢.随访3～12个月,股浅动脉再次闭塞2例,胫前或胫后动脉闭塞7例,3例趾尖部干性坏死.结论 血管腔内介入治疗对改善膝下缺血症状疗效显著,有助于提高缺血肢体的救肢率,是治疗下肢缺血性病变安全有效的方法.     

Venous interventions--part 1: techniques and lower torso thromboses

Venous thrombosis is one of the most common vascular diseases. Without treatment, pulmonary embolism is a potentially life-threatening complication. Long-term complications are chronic venous insufficiency and post-thrombotic syndrome. Medical anticoagulation is currently the standard therapy, since it prevents appositional thrombus growth although it usually can not prevent the development of post-thrombotic syndrome. The structure of the thrombotic material often leads to partial recanalisation with residual stenosis. Early and sufficient systemic thrombolysis with adequate concentration may achieve disintegration of the thrombus and preservation of venous valve function. Supplementary to conservative therapy, local catheter thrombolysis is possible even in cases with contraindications for a systemic thrombolysis therapy. Additional interventional techniques reduce the required concentration of the thrombolytic. Venous stenosis can be treated by balloon angioplasty and stent implantation. This article reviews the different percutaneous treatment options as well as their application and usefulness in thrombosis of the lower torso.     

经腘静脉置管接触性溶栓治疗急性下肢深静脉血栓形成应用价值研究

目的探讨经患侧腘静脉置管接触性溶栓(CDT)治疗急性下肢深静脉血栓形成(DVT)的临床疗效。方法回顾性分析自2012年3月至2017年3月收治的39例应用经患侧腘静脉CDT治疗急性DVT患者的临床资料。所有患者均在腔静脉滤器保护下经患侧腘静脉置管CDT。记录置管成功率,健、患肢周径差值,静脉血栓评分,静脉再通率,深静脉瓣膜保存率,介入治疗并发症与下肢深静脉血栓形成后综合征(PTS)的发生率等指标并评价疗效。结果所有患者均穿刺置管成功,置管成功率为100.0%(39/39)。患者治疗前后的健、患肢周径差值分别为(6.12±1.03)cm与(2.55±0.76)cm,差异有统计学意义(P<0.05),肢体肿胀消退明显。患者治疗前后静脉血栓评分为(5.73±0.94)分与(2.13±1.60)分,差异有统计学意义(P<0.05),血栓消融明显,静脉再通率为(64.23%±16.21%)。39例患者中,1例患者出现置管处炎症,1例患者出现穿刺处血肿,1例患者溶栓后出现髂静脉狭窄并行髂静脉支架植入术治疗,即介入治疗并发症的发生率为7.7%(3/39)。随访6~12个月,34例患者完成随访,随访率为87.2%(34/39),无DVT复发与肺栓塞发生。深静脉瓣膜保存率为(76.14%±9.15%),PTS的发生率为15.4%(6/39)。结论应用经患侧腘静脉CDT治疗急性DVT安全有效。