外周动脉疾病的治疗性血管生成

由动脉硬化、炎症、血栓和栓塞等原因引起四肢动脉供血不足的疾病称为外周动脉闭塞性疾病，其病率约在10％，在70岁以上人群中患病率增加至15％～20％。通过手术或介入的方法进行血管成形是最常用和有效的治疗方法。当血管成形手术因解剖因素或其他原因不能进行时，治疗的方法相当有限，病情严重时患者出现静息痛、溃疡、坏疽等，最终常导致截肢。前列腺素类药物短期内可缓解病情，但用药超过6个月以上时不再产生明显效果。     

血管内超声溶栓治疗外周动脉血栓形成

近年来血管内超声治疗得到迅速发展 ,应用范围在不断扩大 ,我们应用血管内超声技术对 6例外周动脉血栓形成患者进行了血管内超声溶栓治疗 ,取得了较好疗效 ,现报导如下 :1　材料与方法男 5例 ,女 1例 ,年龄 43～ 6 5岁 ,5例为动脉血栓形成 ,1例为肱动脉血栓形成 ,缺血时间为 4～ 13小时。急性缺血指征为患者突然肢体远端苍白 ,疼痛难忍 ,皮温低 ,桡动脉(1例 )、足背动脉 (5例 )搏动消失。经股动脉和肱动脉造影显示 5例为动脉血栓形成 ,1例为肱动脉血栓形成。对 5例动脉血栓形成患者采用同侧股动脉顺行穿刺成功后插入 7Ｆ扩张导管 ,通…     

外周动脉疾病患者运动训练的最佳证据总结

目的 检索、汇总外周动脉疾病（peripheral arterial disease,PAD）患者运动训练的最佳证据,为临床外周动脉疾病患者运动训练干预提供循证依据。 方法 检索UpToDate、美国血管外科学会网站、欧洲血管外科学会网站、Cochrane Library、PubMed、Springer Link、Embase、CINAHL、医脉通、中华医学会血管外科分会网站、超星期刊数据库、中国知网、万方数据库、中文科技期刊数据库针对PAD患者进行运动训练的证据。证据来源包括临床指南、证据总结、专家共识、系统评价及荟萃分析等。文献检索时限为建库至2021年7月1日。此外,由2名研究者对所纳入的文献质量进行评价和提取所需资料。 结果 共纳入14篇文献。从运动安全、运动时机、运动方式、运动强度、运动时间、效果评价、注意事项7个方面,共提取20条最佳证据。 结论 运动训练可以提高PAD患者的步行能力,改善生活质量,建议在保证安全的前提下应进行运动训练干预。该研究证据总结过程严谨、内容全面。在实际临床工作中,医护人员在应用证据时需考虑到实际的应用环境和患者的个体情况。     

超声消融术治疗外周动脉完全闭塞性病变的护理配合

对侧标识经皮血管腔内超声消融治疗外周动脉完全闭塞性病变术是一种新的安全有效的方法。作就超声消融治疗39例外周动脉完全闭塞性病变术的护理配合，包括患的术前准备、治疗间及物品准备、治疗仪设定、术中监测以及严格无菌操作等一套工作经验进行了总结，对术中配合应注意的问题进行了讨论。     

动脉疾病的微创治疗32例分析

目的探讨介入技术在动脉疾病中的应用及与手术联合使用的意义。方法对32例不同的动脉疾病采用介入技术或介入联合手术的方法进行治疗,对临床治疗效果及介入技术的应用进行分析。结果31例患者治疗成功,1例失败。平均随访9个月,1例降主动脉瘤破裂形成食道瘘患者,出院后1个月因支架感染而死亡。其余症状均消失或改善。结论动脉疾病的介入治疗可以减轻患者痛苦,减少手术风险,缩短住院时间。与手术联合使用可以减少手术的创伤或扩大介入技术的运用范围。     

从CLIPS研究看外周动脉疾病患者的抗血小板治疗

1 CLIPS研究表明.阿司匹林显著降低外周动脉疾病(PAD)患者血管事件 最近一期内科学杂志刊登了CLIPS研究(Critical Leg Ischmia Prevention Study)结果,该研究显示,与安慰剂相比,阿司匹林100mg/d可使PAD患者主要心血管事件发生危险降低64%,同时两组出血性事件发生率差异并无统计学意义;而大剂量抗氧化维生素并无降低PAD患者心血管事件发生率的作用,以上结果引起了广泛关注.     

血管内支架治疗外周动脉狭窄或阻塞性疾病

目的 探讨血管内支架治疗外周动脉狭窄或阻塞性疾病的疗效和预后。方法 应用PTA加血管内支架技术,治疗13例外周动脉狭窄性疾病的患者。结果 13例动脉造影显示4例颈动脉、4例锁骨下动脉、4例肾动脉及1例腹主动脉有不同程度狭窄。12例应用导丝顺利完成PTA治疗后,置放自扩展式Wall stent、记忆合金式Symphony及Angiomed支架12支,患者治疗后临床症状消失或缓解。术后造影显示血管及支架通畅,近期效果满意。结论 应用PTA加血管内支架是治疗外周血管狭窄或闭塞性疾病的理想方法。     

介入放射学：运动和PVI改善外周动脉疾病

外周动脉疾病（PAD）可能是未来心脏事件和卒中的征象,很多患者可能没有意识到自己的PAD大多为下肢动脉粥样硬化减慢下肢血流所导致。半数以上的患者没有症状而且不能感觉到PAD的典型预警征象——行走或锻炼时下肢疼痛,而静息时疼痛消失。这一症状通常是衰老的征象,例如下肢和足的麻木、皮温减低、溃疡或伤痕不愈。多数PAD可通过药物（如抗凝剂或扩管药）、改变生活方式（如戒烟）、节食和有计划的锻炼来治疗。早期发现PAD,可以选择最有效且损伤更小的血管内介入治疗（pvI）。（（the Journal of Vascular and Interventionnal Radiology）〉杂志的一项研究发现血管内介入治疗在PAD康复中发挥重要作用。研究者发现PVl联合督导锻炼疗法比单独介入治疗能更有效的改善PAD患者的行走能力。此研究中所有的PAD患者均因动脉粥样硬化行PVI。结果发现PVI后联合锻炼疗法比单独PVI能更有效的增加行走距离,表明在治疗PAD时锻炼疗法是PVI的有效辅助手段。     

腹膜透析患者外周动脉疾病及相关危险因素分析

目的探讨腹膜透析患者外周动脉疾病(PAD)及其相关危险因素。方法本研究以2011年1月至2011年12月间在平煤神马医疗集团总医院就诊的150例腹膜透析患者为观察对象,对患者的外周动脉疾病发生情况和危险因素进行分析。结果非PAD患者与PAD患者相比,其C-反应蛋白、血糖、血清白蛋白、尿素氮等各项临床指标比较差异均有统计学意义(P<0.05)。患者主要的危险因素为C-反应蛋白和血清白蛋白等指标。结论 C-反应蛋白和血清白蛋白是导致腹膜透析患者发生外周动脉疾病的主要危险因素。     

药物洗脱支架在膝下动脉病变的初步应用

目的 探讨药物洗脱支架在膝下动脉应用的可行性及临床价值。方法 对11例接受Deep球囊扩张术后效果不满意的膝下动脉病变患者植入国产药物洗脱支架,观察术后临床症状改善情况,比较术前及术后的踝肱指数,应用超声随访支架的再狭窄情况。结果 患者术后缺血症状均明显改善,踝肱指数为0.84±0.09,较术前(0.35±0.12)明显增高(P<0.05)。术后6个月, 11例患者膝下动脉支架均血流通畅,未见狭窄;术后随访12个月的8例患者中,2例支架近端轻度狭窄(直径减少小于30%)。结论 药物洗脱支架用于治疗膝下动脉病变的近期疗效肯定,中远期效果有待进一步观察。     

Endovascular stent implantation for treatment of peripheral artery disease

Endovascular stent implantation is a rapidly emerging technology for treatment of arterial obstructions in the entire circulation. During recent years, several randomized studies evaluated the effects of stenting in lower limb arteries. We herein provide an overview on data of trials in the iliac and femoropopliteal vessel area discussing the benefits and limitations of endovascular stents. In the iliac arteries, midterm and long-term data from one randomized trial including analysis on patency, clinical outcomes, cost-effectiveness and quality of life indicate that balloon angioplasty with selective stenting remains the therapy of choice for endovascular revascularization. In the femoropopliteal arteries, balloon-expanding stents were not superior to balloon angioplasty for treatment of short lesions, and self-expanding nitinol stents also failed to show a beneficial effect in short lesions below 5 cm. However, including longer lesions, one randomized trial indicated a beneficial effect of nitinol stents in lesions with a median length around 10-12 cm. Further studies and longer follow-up intervals are needed to confirm these data. Meanwhile, balloon angioplasty with optional stenting also remains the recommended endovascular approach for the femoropopliteal segment.     

Ethnicity and peripheral artery disease

Peripheral arterial disease (PAD) is an important healthcareproblem and is an indicator of widespread atherosclerosis inother vascular territories, such as the cerebral and coronarycirculations. PAD is associated with considerable morbidityand mortality. Most population-based studies investigating PADprevalence and risk factors for its development and progressionhave been based on predominantly White ethnic groups. Much lessis known about the characteristics of this disease in otherethnic groups. Understanding the epidemiology of PAD amongstethnic minority groups is relevant, given that the populationof minority ethnic groups in countries such as the United Kingdomrose by 53% between 1991 and 2001 and is expected to rise furtherin the future. This article aims to provide an overview of possiblepathophysiological differences between ethnic groups for PAD,focussing predominantly on South Asians (people originatingfrom India, Bangladesh and Pakistan) and Blacks (people of BlackCaribbean and Black African descent) as these groups comprisethe majority of all ethnic minorities in the United Kingdom.     

Stimulation of collateral artery growth: a potential treatment for peripheral artery disease

In the course of peripheral artery occlusive disease, blood flow to peripheral tissue progressively decreases in a substantial portion of patients, leading to insufficient oxygenation and to the occurrence of claudication or critical limb ischemia. Arteriogenesis (collateral artery growth) is a powerful natural mechanism by which large conductance vessels develop that circumvent sites of obstruction. Promising experimental data on both hypoxia-driven angiogenesis as well as monocyte-orchestrated arteriogenesis have raised high hopes for clinical application. Both endothelial growth factors to stimulate angiogenesis (i.e., capillary growth) and monocyte-attracting or -activating substances to stimulate arteriogenesis, have been proposed as potential new therapeutic agents. However, transferring the promising experimental results into clinical practice has been more cumbersome than initially anticipated. Some recent clinical studies are now focusing more specifically on the stimulation of arteriogenesis. This review will critically evaluate the results of preclinical and clinical investigations on the stimulation of vascular growth, focusing specifically on the peripheral circulation.     

糖尿病合并下肢动脉病变的诊治

糖尿病合并下肢动脉病变临床上并不少见,但由于其发病隐匿、进展缓慢,加之患者往往合并其他的糖尿病并发症而使下肢缺血的临床表现不典型,因此该症尚未受到足够的重视。本文概述了该症的临床特点、诊断和治疗。     

Advanced interventional techniques and therapies in the treatment of peripheral artery disease below the knee

In patients with peripheral artery disease, the options for interventional therapy of critical limb ischemia have increased within the last few years. Different antegrade and retrograde techniques for vascular recanalization are used to pass even complex and long stenoses or occlusions below the knee (BTK). A variety of diverse wires, catheters and stent types allows arterial recanalization of the lower leg and increases the impact of therapeutic efforts. This review article describes indications, advanced techniques as well as materials in BTK interventions and summarizes current evidence-based study results.     

Angiogenic therapy for coronary artery and peripheral arterial disease

Neovascularization in chronically ischemic adult cardiac and skeletal muscle results from the processes of angiogenesis, arteriogenesis and vasculogenesis. Therapeutic angiogenesis describes an emerging field of cardiovascular medicine whereby new blood vessels are induced to grow to supply oxygen and nutrients to cardiac or skeletal muscle rendered ischemic as a result of progressive atherosclerosis. Various techniques have been utilized to promote new blood vessel growth in the heart and extremities, including mechanical means such as surgical or percutaneous myocardial laser revascularization, angiogenic growth factor therapies involving members of the vascular endothelial growth factor and fibroblast growth factor families, and more recently, cellular-based therapies using stem cells known as endothelial progenitor cells or angioblasts. The following review discusses each of these treatment strategies in detail including both preclinical and clinical data for their use in peripheral arterial and coronary artery disease.