动脉切开取栓联合股动脉置管治疗老年急性下肢动脉栓塞的疗效

目的探讨老年急性下肢动脉栓塞患者应用动脉切开取栓联合股动脉置管治疗的疗效。方法回顾性分析该院血管外科经动脉切开取栓联合股动脉置管治疗的老年急性下肢动脉栓塞患者的临床资料共34例(34条肢体),分析患者的一般资料、围术期情况及患肢的保肢率、再栓塞率等。结果 34例患者均取栓成功,术后踝肱指数(ABI)较术前明显改善(P<0.05),术后死亡2例,截肢1例。术后保肢率97.1%,死亡率5.9%。31例患者获得随访,随访6~30个月,平均(18±6)个月,随访期内死亡5例,无截肢病例。随访患者中21例术后长期(>1年)规律抗栓治疗,其中死亡1例,再次发生动脉栓塞1例;术后未长期规律抗栓治疗患者10例,其中死亡4例,再次发生动脉栓塞3例。结论对于老年急性下肢动脉栓塞的患者,动脉切开取栓联合股动脉置管是一种安全、有效的治疗手段,术后长期(>1年)规律的抗栓治疗能够有效降低死亡率和再次动脉栓塞的概率。     

球囊导管取栓术在急性下肢动脉栓塞的应用

本文报告53例(75条腿)急性下肢动脉栓塞球囊导管取栓木的治疗结果。全组疗效优良率(肢体存活率)82.7%,死亡率17%,对影响治疗效果的主要因素进行了讨论,并提出了球囊导管取检术适应证的选择原则。     

下肢急性动脉栓塞DSA下取栓116例临床分析

急性肢体动脉栓塞是临床较为常见的急症之一,一旦发生,迅速引起肢体的严重缺血,导致肢体坏疽甚至危及生命.1963年,Fogarty首先采用球囊导管,经股动脉作腹主动脉和髂动脉的栓子取出术,显著提高了本病的治疗效果,成为抢救急性动脉阻塞最有效的方法,但该手术方式在挽救大批患者肢体的同时,术后再栓塞率、截肢率依然很高.近年来数字减影血管造影(Digital Subtraction Angiography,DSA)技术逐渐在血管外科领域被广泛应用,DSA下双腔动脉导管取栓正逐步得到开展.我院血管外科自2007年4月至2010年12月对116例急性下肢动脉栓塞的病人采用DSA下取栓,取得了良好的临床效果.     

急性肢体动脉栓塞的外科治疗及预后因素

目的 :探讨急性肢体动脉栓塞的外科治疗方法和影响预后的因素。方法 :4 0例急性肢体动脉栓塞的患者行动脉切开Fogarty导管取栓术 ,并结合溶栓抗凝治疗。结果 :临床治愈 2 0例 ,好转 8例 ,截肢 9例 ,死亡 3例。发病 12h内手术者无截肢及死亡。死亡原因包括急性心肌梗死 (1例 )和多器官功能衰竭 (2例 )。结论 :Fogarty导管取栓术是治疗急性肢体动脉栓塞的首选方法 ,结合溶栓抗凝治疗可取得满意效果。高龄、糖尿病及心肺血管疾病是术后死亡的重要危险因素。     

急性动脉栓塞69例临床分析

目的 探讨急性动脉栓塞的早期诊断方法、手术时机、手术及非手术治疗与预后的关系。方法 本组69例均经非手术治疗。发病6h以内手术10例次,6-12h手术26例次,13-48h手术34例次,2d以上手术37例次。单纯非手术治疗2例;1例肠系膜上动脉栓塞行腹部探查术;9例上肢动脉栓塞和59例下肢动脉栓塞中57例先应用Fogarty导管行取栓术,其中9例下肢动脉硬化狭窄处栓子行内剥脱8例及动脉旁路术1例。术中同时应用尿激酶10-30万U加生理盐水40ml中栓基远端动脉内注入,以溶解小动脉内血栓。结果 单纯非手术治疗2例均死亡;发病6h以内手术者救肢率为100％,6-12h手术者为83.7％。结论 急性动脉栓塞的早期栓子摘除术的最佳手术时机为发病后12h以内;提高救肢率和治愈率的关键是早期诊断,合理治疗,尽早手术取栓及积极治疗原发心脏疾病。     

DSA下肢体动脉切开取栓术在急性肢体缺血疾病中的临床应用效果探讨

目的探讨数字减影血管造影(DSA)下行肢体动脉切开取栓手术治疗急性肢体缺血的临床应用效果。方法收集该院2012-09~2019-06接受DSA下肢体动脉切开取栓手术的74例急性肢体缺血患者(共79条患肢)的临床资料,回顾性分析保肢率、手术方式、膝下动脉开通比例、并发症及随访结果,用以评价手术疗效。结果所有74例急性肢体缺血患者均顺利完成手术,术中均未发生与操作相关并发症,61例患者(共64条患肢)成功保肢,保肢率为81.01%(64/79)。其中59例下肢手术患者中,胫前动脉总开通率为83.05%(49/59),胫后动脉总开通率为72.88%(43/59),腓动脉总开通率为84.75%(50/59)。有效随访的61例患者无手术并发症导致死亡的病例。结论DSA下肢体动脉切开取栓手术治疗急性肢体缺血,有利于提高保肢成功率,减少操作相关并发症发生。     

风湿性心脏病并发下肢动脉栓塞的处置体会(附13例报告)

【摘要】 目的 总结风湿性心脏病并发下肢动脉栓塞的诊治经验。方法 回顾分析我院2005年至2015年收治的13例风湿性心脏病患者并发下肢动脉栓塞的临床资料。在DSA下进行下肢动脉栓塞的介入治疗,根据栓塞特点选择血栓抽吸、导管取栓、置管溶栓、球囊扩张等不同的治疗方法,下肢缺血改善后及时行心脏手术,术后服用华法林及控制心室率的药物。结果 本组13例患者经介入治疗后下肢缺血均改善, 1例避免了膝上截肢,2例避免了截足趾。11例患者行心脏手术,二尖瓣置换8例,二尖瓣置换 主动脉瓣置换3例,同期三尖瓣成形4例,左心房折叠3例,冠状动脉搭桥2例,均行左心耳闭合。本组中有38.5%(5/13)的患者合并脑梗塞,治疗中发生出血性脑梗塞2例,其中1例死亡。随访半年以上无栓塞事件发生。结论 接受有效抗凝治疗的患者过少可能是本组患者发生下肢动脉栓塞的重要原因。对并发下肢动脉栓塞的患者,应常规行头颅CT检查,警惕无症状脑梗塞的存在,预防出血性脑梗塞的发生。推荐在DSA下进行下肢动脉栓塞的治疗。左心耳血栓的术前诊断与术中情况多不相符。术中合理处理左心房、术后规范抗凝治疗及有效控制心室率可预防再栓塞事件。     

急性下肢动脉缺血的个体化诊治

目的探讨急性下肢动脉缺血的诊断及治疗方法,提高急性下肢动脉缺血的诊治率。方法对37例急性下肢动脉缺血患者采用彩色多普勒超声和CT血管造影等多种检查,进行下肢动脉缺血诊断,疾病分期Ⅰ期21例,Ⅱ期9例,Ⅲ期5例,Ⅳ期2例,患者分别应用切开取栓、腔内溶栓、腔内成形等多种个体化治疗,回顾性分析其临床资料。结果 37例患者中,围术期死亡2例分别为Ⅲ、Ⅳ期患者;低位截肢5例患者中Ⅱ期2例,Ⅲ期3例;高位截肢1例患者为Ⅲ期,其余患者围术期临床缺血症状改善良好。结论早期有效的诊断和个体化治疗是急性下肢动脉缺血的关键。特别要重视急性动脉栓塞和急性动脉血栓形成的鉴别,采取个体化治疗,提高保肢的成功率。     

杂交手术在急性下肢动脉缺血中应用的临床体会

目的:探讨杂交手术在急性下肢动脉缺血中的应用价值。方法:回顾分析2009年9月至2013年12月血管外科收治的急性下肢动脉缺血患者48例,根据手术方式将其分为单纯股动脉切开导管取栓术组,(A组28例)和杂交手术组(B组20例),比较两组手术方法的效果,分析影响保肢的因素。结果:A组,死亡2例,病死率7.14%。一期截肢3例,二期截肢2例,总体保肢率为82.14%(23/28);B组,死亡1例,病死率5%。一期截肢1例,总体保肢率为95%(19/20),B组的总体截肢率、一期截肢率和二期截肢率均低于A组。结论:杂交手术是治疗肢体急性动脉栓塞极为有效的方法,早期诊断,早期手术,及时发现并处理恢复血流后再灌注损伤与肌病肾病性代谢综合征,是挽救生命,挽救肢体,取得满意疗效的关键。有条件医院杂交手术应作为治疗急性下肢缺血的首选手术方式。     

21例老年急性动脉栓塞取栓治疗

由于我国老年化问题越加严重，老年疾病合并急性动脉栓塞患者临床愈发常见。多数患者由于年高体弱，基础病多，治疗不便等因素而影响手术取栓时机和疗效。我院1996年以来共收治〉60岁急性动脉栓塞患者21例，均行Fogarty导管取栓治疗。取得满意疗效，现报道如下。     

外伤性颈内动脉海绵窦瘘的血管内栓塞治疗:20例回顾性病例系列研究

目的 评价血管内栓塞治疗外伤性颈内动脉海绵窦瘘(traumatic carotid-cavernousfistula,TCCF)的临床效果.方法 20例TCCF患者,10例采用可脱性球囊栓塞,4例采用可脱性球囊结合弹簧圈栓塞,2例采用单纯弹簧圈栓塞,3例采用弹簧圈结合Onyx胶栓塞,1例采用覆膜支架置入术.其中,有2例因球囊早泄而再次栓塞.结果 20例患者一次性栓塞成功18例,二次栓塞成功2例.颈内动脉通畅率100％,未发生手术相关并发症.结论 血管内栓塞是治疗TCCF的一种简单、安全和疗效可靠的方法.     

Preoperative microcoil embolization of the common hepatic artery for pancreatic body cancer

AIM: To evaluate safety and feasibility of microcoil embolization of the common hepatic artery under proper or distal balloon inflation in preoperative preparation for en bloc celiac axis resection for pancreatic body cancer.METHODS: Fifteen patients (11 males, 4 females; median age, 67 years) with pancreatic body cancer involving the nerve plexus surrounding the celiac artery underwent microcoil embolization. To alter the total hepatic blood flow from superior mesenteric artery (SMA), microcoil embolization of the common hepatic artery (CHA) was conducted in 2 cases under balloon inflation at the proximal end of the CHA and in 13 cases under distal microballoon inflation at the distal end of the CHA.RESULTS: Of the first two cases of microcoil embolization with proximal balloon inflation, the first was successful, but there was microcoil migration to the proper hepatic artery in the second. The migrated microcoil was withdrawn to the CHA by an inflated microballoon catheter. Microcoil embolization was successful in the other 13 cases with distal microballoon inflation, with no microcoil migration. Compact microcoil embolization under distal microballoon inflation created sufficient resistance against the vascular wall to prevent migration. Distal balloon inflation achieved the requisite 1 cm patency at the CHA end for vascular clamping. All patients underwent en bloc celiac axis resection without arterial reconstruction or liver ischemia.CONCLUSION: To impede microcoil migration to the proper hepatic artery during CHA microcoil embolization, distal microballoon inflation is preferable to proximal balloon inflation.     

经皮冠状动脉介入治疗并发心包积液及心脏压塞的临床分析

目的 了解经皮冠状动脉介入治疗(PCI)中心包积液／心脏压塞发生率、发生的相关因素、处理以及预后，为PCI的正确操作及合理选用器械提供参考。方法 分析了1246例PCI资料，包括住院病历、PCI操作记录、护理记录和影像学资料，判定心包积液／心脏压塞发生原因、时间、临床表现、处理方式和结果。结果 共8例心包积液(0．64％)、3例心脏压塞(0．24％)，其中10例(91％)在导管室确诊，1例(9％)延期发现。冠状动脉造影直接发现导引钢丝和／或球囊致冠状动脉穿孔9例(81．8％)，其中球囊通过冠状动脉破口未扩张2例，球囊通过冠状动脉破口并扩张1例，冠状动脉穿孔多发生在慢性完全闭塞性病变(CTO)；通过临床表现、超声心动图证实起搏电极导线致右心室穿孔2例(18．2％)，均出现在心肌梗死后患者。球囊通过冠状动脉破口并扩张1例，发生迟发性心脏压塞，6h后急诊外科干预引流后治愈；右心室临时起搏电极导管穿破右心室2例，1例行心包穿刺术，另1例心包穿刺后留置猪尾导管引流2d成功治愈。结论 冠状动脉及右心室穿孔是PCI并发心包积液／心脏压塞的主要原因，前者多发生在CTO患者，后者易出现于心肌梗死后患者。正确的操作方法及合理的器械选择可能减少此并发症的发生。冠状动脉穿孔较心室穿孔易于诊断，心包积液／心脏压塞多数能在导管室早期发现，并能得以合理的处理。     

Percutaneous coronary intervention in myocardial infarction. Current concepts

Percutaneous mechanical reperfusion during acute myocardial infarction with ST-segment elevation has proved to be the most effective way of quickly restoring adequate flow in the affected coronary artery. Randomized clinical trials have shown that percutaneous coronary intervention (PCI) is superior to thrombolysis. Initial fears about the use of stents in primary angioplasty vanished when clinical studies demonstrated that they gave better results than those obtained under optimal conditions with balloon angioplasty. The need to transfer patients to a cardiac catheterization laboratory for primary PCI does not decrease the efficacy of this form of treatment, which remains superior to immediate thrombolysis at the admitting hospital. Distal embolization can alter the situation by preventing myocardial reperfusion. Although there are many therapeutic strategies for managing thrombotic lesions, only early administration of glycoprotein IIb/IIIa inhibitors, direct stenting, and use of an X-Sizer device followed by stent implantation have been shown in randomized studies to lead to significant improvements in clinical or angiographic parameters. No technique has been shown to prevent damage due to myocardial reperfusion. However, it would be difficult to improve upon the good results achieved with PCI in the majority of patients. Rescue PCI is indicated when thrombolysis appears to have failed, especially when a catheterization laboratory is close by or when patients can be transferred early to a center with angioplasty facilities. For most cases of cardiogenic shock, PCI is the only therapeutic modality currently recommended.     

应用切割球囊结合支架术治疗冠状动脉分叉处病变89例

目的 :评价经皮冠状动脉腔内切割球囊成形术 （PTCBA）结合支架术治疗冠脉分叉处病变的安全性及疗效。方法 :对 89例冠心病患者主支病变应用 PTCBA预扩张后置入支架、分支病变单行 PTCBA而不置入支架 ,观察其冠脉病变特点、手术过程相关因素、手术成功率、并发症和近、中期随访结果。结果 :89例患者中分叉处病变位于前降支 /对角支占 71% ,回旋支 /钝圆支占 2 5 % ,右冠脉 /后降支或后侧支占 4%。对分支血管行 PTCBA后 1例因残余狭窄 >5 0 %而植入支架 ,1例因并发轻度钙化且分支成角较大切割球囊未通过 ,改用常规 PTCA球囊扩张成功。病变 PTCBA成功率达 97.8% ;无院内死亡、急性心肌梗死 （AMI）、急性心包填塞及急诊冠脉搭桥术等严重并发症。对手术成功的 87例术后临床随访 3～ 2 6个月 ,无死亡及 AMI等心脏事件发生。临床心绞痛复发率 17.2 %。复查冠脉造影 （CAG）率 5 6.3 % ,示 49处分叉病变主支支架内再狭窄率 14.3 % ,分支血管再狭窄率 18.4%。结论 :PTCBA结合支架术治疗冠脉分叉处病变是一种安全、有效的介入治疗技术 ,其成功率高、并发症少 ,近、中期疗效满意     

Nonsurgical retrieval of embolized coronary stents.

Embolization of coronary stents before deployment is a rare but challenging complication of coronary stenting. Different methods for nonsurgical stent retrieval have been suggested. There were 20 cases (0.90%) of intracoronary stent embolization among 2,211 patients who underwent implantation of 4,066 stents. Twelve of 1,147 manually crimped stents (1.04%) and eight of 2,919 premounted stents were lost (0.27%, P < 0.01) during retraction of the delivery system, because the target lesion could not be either reached or crossed. Percutaneous retrieval was successfully carried out in 10 of 14 patients (71%) in whom retrieval was attempted. In 10 patients, stent retrieval was tried with 1.5-mm low-profile angioplasty balloon catheters (success in 7/10) and in seven cases with myocardial biopsy forceps or a gooseneck snare (success in 3/7). Three patients (15%) underwent urgent coronary artery bypass surgery after failed percutaneous retrieval, but their outcomes were fatal. In two patients, stents were compressed against the vessel wall by another stent, without compromising coronary blood flow. In two patients, a stent was lost to the periphery without clinical side effects; treatment was conservative in these cases. Embolization of stents before deployment is a rare but serious complication of coronary stenting, with hazardous potential for the patient. Manual mounting of stents is associated with a significantly higher risk of stent embolization. Stent retrieval from the coronary circulation with low-profile angioplasty balloon catheters is a readily available and technically familiar approach that has a relatively high success rate.     

Clinical and angiographic outcome after cutting balloon angioplasty

The cutting balloon is a new device for coronary angioplasty, that, by the combination of incision and dilatation of the plaque, is believed to be promising for treatment of in-stent restenosis. The purpose of the study was to evaluate the safety and efficacy of CBA. We reviewed the immediate and 6-month follow-up angiographic and clinical outcome of 147 patients (109 men and 38 women) with a mean age of 67.3 +/- 10 undergoing this procedure at eight interventional centers in Austria. The target lesions treated with CBA were in-stent restenosis in 61% of patients, stenosis after balloon angioplasty in 8% of patients, and native lesions in 33% of patients. Sixty-five percent of the patients included had multivessel disease. Lesion type was A in 18% of patients, B1 in 31% of patients, B2 in 39% of patients, and C in 12% of patients. The degree of stenosis was 87% +/- 9%, the length of the target lesion treated with CBA was 8.8 +/- 5.1 mm. Target vessel was left circumflex artery in 22 cases, right coronary artery in 36 cases, and left anterior descending artery in 89 cases. The overall procedural success rate was 90.5%. "Stand-alone" CBA was performed in 63% of patients, the procedure was combined with coronary stenting in 16% of patients, and with balloon angioplasty in 21% of patients. Coronary complications occurred in eight cases (5.4%) with coronary dissection in seven (total dissection rate of 4.7%) and urgent bypass surgery in one case (0.7%). No further complications such as death, occlusion, or perforation of coronary arteries, embolization, or thrombosis were observed. Six-month clinical follow-up revealed q-wave myocardial infarction in 2.7% of patients, aortocoronary bypass surgery in 8.5% of patients, and repeated percutaneous coronary intervention in 17% of patients (11.5% with stenting). Six-month angiographic follow-up of patients with recurrent angina showed target lesion restenosis (> 50% diameter stenosis) in 14% of patients, late lumen loss with < or = 50% diameter stenosis in 6% of patients and progression of "other than target" lesions with > 50% diameter stenosis in 14% of patients. This series demonstrates the safety and feasibility of cutting balloon angioplasty in patients with complex coronary artery disease and in-stent restenosis.     

聚乙烯醇和明胶海绵联合栓塞治疗急性大咯血

目的 探讨聚乙烯醇(PVA)和明胶海绵(GS)联合栓塞支气管动脉治疗急性大咯血临床疗效。方法 采用Seldinger法，对内科治疗无效的47例患者，在电镜引导下经支气管动脉进行栓塞，GS组21例，PVA GS组26例，并随访2年。结果 随访1个月GS组有效率(19／21)90．5％，PVA GS组有效率(23／26)88．5％；随访6个月GS组有效率(12／21)57．1％，PVA GS组有效率(20／26)76．9％；随访2年GS组有效率(5／21)23．8％，PVA GS组有效率(17／26)65．4％。结论：PVA GS联合栓塞支气管动脉治疗急性大咯血疗效好，复发率低。     

SafeCut球囊处理分叉病变分支血管的疗效和安全性观察

目的评价SafeCut球囊成形术治疗冠脉分叉处分支血管中病变的安全性及疗效方法。方法42例冠心病患者46个分叉病变主支病变置入支架,分支病变单行SafeCut,球囊扩张而不置入支架,观察其手术过程,手术成功率,并发症和近期随访结果。结果42例患者46个分叉病变中位于前降支/第一对角支占62%,回旋支/钝圆支占29%,右冠脉/后降支或后侧支占10%。对分支血管行SafeCut球囊扩张后有2例因内膜严重撕裂而置入支架,其余病变残余狭窄为10%～50%,成功率达100%,无急性心肌梗死等严重并发症。术后临床随访6～20个月,无死亡及心肌梗死等心脏事件发生。结论SafeCut球囊成形术治疗冠脉分叉处分支血管病变安全,有效,其成功率高,并发症少,近期疗效满意。     

老年颅内动脉瘤患者血管内栓塞的临床研究

目的探讨老年颅内动脉瘤患者的临床、影像特点和血管内治疗方法的疗效。方法44例60岁以上患者共52个颅内动脉瘤，全部经全脑血管造影明确诊断。针对老年患者路径动脉迂曲、狭窄形成等特点，栓塞时，可采用多种人路，包括股动脉、颈动脉或肱动脉等。采用三维弹簧圈成篮技术、联合支架或球囊重塑形技术等栓塞宽颈动脉瘤和梭形动脉瘤。结果52个动脉瘤有49个被成功实施栓塞术(成功率为94．2％)；44例患者术后3个月格拉斯哥预后评分(GOS)良好33例，中残6例，重残3例，死亡2例。结论血管内栓塞治疗适于合并症多、血管条件较差的老年顷内动脉瘤患者。