基于超声征象建立股浅动脉支架再狭窄的风险预测评分模型

目的建立综合、有效的股浅动脉支架再狭窄风险预测模型,在术前预测支架再狭窄的可能,为手术方案的选择提供指导意见。方法回顾性纳入2016年1月至2018年1月在首都医科大学宣武医院接受股浅动脉支架治疗的患者328例(共381条患肢)作为建模队列。以超声作为评价手段,依据多因素Logistic回归分析筛选支架再狭窄的独立危险因素,按其权重赋值,建立支架再狭窄风险预测评分模型。以受试者工作特征(receiver operating characteristic,ROC)曲线验证模型的区分度,并根据其最佳界值将评分模型分为支架再狭窄低危组和高危组。结果多因素Logistic回归分析显示,8项危险因素被纳入评分系统并建立支架再狭窄风险预测模型,钙化斑块、腘动脉收缩期峰值流速<40 cm/s、膝下流出道评分≥4分、踝臂指数<0.5、女性均赋值1分,患者合并脑梗死、慢性肾病、病变总长度15.0~24.9 cm均赋值2分,病变总长度≥25.0 cm赋值3分,模型最高计12分。以数字减影血管造影(DSA)为金标准,经ROC曲线验证,提示该评分体系具有较高的预测价值[ROC曲线下面积(AUC)=0.775,95%CI=0.727~0.824,P<0.001]和拟合优度(χ²=4.921,P=0.766),一致性检验Kappa值为0.609。将评分模型进一步分为再狭窄低危组(0~5分)和再狭窄高危组(6~12分),其敏感性为68.1%,特异性为74.6%,准确性为72.7%。结论股浅动脉支架再狭窄风险预测评分模型可在术前较准确地预测再狭窄的发生,为精准制定手术方案提供理论依据。     

An ultrasonic measurement of superficial femoral artery wall thickness

An ultrasonic measurement of the superficial femoral artery wall thickness was performed on 16 volunteers. The measurement included all echogenic tissue between the lumen of the superficial femoral artery and the lumen of the superficial femoral vein. The average arterial wall plus vein wall thickness in volunteers with peripheral arterial disease was 2.13 +/- 0.87 mm, significantly greater than the 1.27 +/- 0.50 mm found in those without detectable peripheral arterial disease.     

Malignant fibrous histiocytoma arising from the superficial femoral artery.

Primary sarcomatous arterial tumors are rare. We have reported a case of malignant fibrous histiocytoma in an elderly woman successfully treated by resection of the involved femoral vessel and reconstruction with a PTFE graft. The long-term result in this patient is presently uncertain.     

Pseudoaneurysm of the superficial femoral artery detected by emergency medicine bedside ultrasound

Background

Femoral artery pseudoaneurysm following by cardiac catheterization is a serious groin complication requiring careful assessment and prompt intervention.

Aims

Risk of femoral artery pseudoaneurysm is estimated at 0.6 to 17 following diagnostic and interventional procedures.

Methods

The clinical usage of bedside ultrasonography as part of the physical examination by attending emergency physicians has increased significantly over recent years.

Results

Bedside Emergency Department ultrasonography provides the clinician with critical information noninvasively, rapidly determining various anatomical structures.

Conclusions

We presented the case of a femoral artery pseudoaneurysm detected by the bedside emergency department ultrasonography secondary to angiographic catheterization.     

"Mechanical" obstruction of the superficial femoral artery with the coronary angioplasty introducer sheath

Cardiac catheterization has become an important tool for diagnosing coronary artery disease, and percutaneous transluminal balloon angioplasty of the coronary arteries has likewise become an important method of treating coronary artery disease. With the increasing number of invasive procedures being done, more and more vascular complications are being documented. I have presented one case of acute arterial insufficiency managed nonoperatively.     

急性股浅动脉支架内血栓形成的介入治疗

目的 探讨DSA引导下采用导引导管取栓和局部溶栓的方法,治疗下肢股浅动脉支架放置术后急性血栓的临床疗效.方法 2008年3月～2012年4月,8例下肢股浅动脉支架放置术后急性血栓形成患者,接受介入引导管取栓及局部溶栓治疗.结果 全组介入治疗成功率100％,无严重并发症.结论 DSA下导引导管取栓和局部溶栓治疗下肢动脉支架急性血栓形成,疗程短、成功率高、疗效显著、并发症少.     

股腘动脉双入路技术在长段股浅动脉闭塞介入治疗中的应用

目的：探讨股腘动脉双入路技术在长段股浅动脉闭塞介入治疗中的安全性及临床应用价值。方法：采用股腘动脉双入路技术介入治疗15例长段股浅动脉闭塞患者,所有患者均在术前行双下肢动脉CTA检查明确闭塞长度及远端流出道情况,均为股动脉入路顺行开通受阻或内膜下成形无法返回真腔时联合腘动脉逆行穿刺,通路建立后对闭塞段行球囊扩张及支架置入术。比较手术前、后患者的症状及踝肱指数变化,术后每隔3个月复查踝肱指数及下肢动脉彩超。结果：15例患者均通过股腘动脉双入路技术使闭塞段动脉获得开通,技术成功率100%,路径图或多普勒引导下1次穿刺腘动脉成功9例,2、3、4次穿刺成功各2例,患者均能够耐受并未出现神经损伤等并发症。14例患者静息痛术后消失,术后踝肱指数为0.68±0.088（P<0.01）,较术前明显升高（0.36±0.12）。随访时间2～16个月,1例足部溃疡未得到控制,于术后2个月行截肢手术;1例患者于术后3个月时再次出现静息痛,彩超示股动脉支架内狭窄,再行PTA术后好转;余患者随访期间未见复发。结论：股腘动脉双入路技术治疗长段股浅动脉闭塞安全性高、患者耐受性好,近期疗效确切,为介入治疗复杂下肢动脉硬化闭塞提供了新思路。     

Duplication of the superficial femoral artery diagnosed primarily on the basis of color Doppler ultrasonography.

Variations of the lower extremity venous system are common, and radiologists may frequently be confronted with such variations during daily clinical practice. However, variations in the arterial system of the lower extremity are extremely rare. The profunda femoris artery and arteries of the cruris are mainly subject to variation. This report describes an extremely rare arterial variation, duplication of the superficial femoral artery (SFA), in terms of the radiologic findings, clinical importance, and embryologic basis.     

Twisting of the Ranger drug‐coated balloon for treating superficial femoral artery disease

Paclitaxel‐coated balloons have demonstrated improved efficacy compared with uncoated percutaneous transluminal angioplasty for femoropopliteal artery disease. While applying a long balloon, twisting of the balloon can be occurred. We reported two cases with twisting of the Ranger drug‐coated balloon for treating superficial femoral artery.     

Stenting as an alternative to open repair in traumatic superficial femoral artery injuries

Lower limb ischemia may occur when a superficial femoral artery (SFA) is injured in blunt or penetrating trauma. Surgical repair of the injured artery can be challenging and time-consuming when there is an associated fracture. Two cases of traumatic SFA injury treated with endovascular stent grafting are described.     

Carotid artery stenting using proximal balloon occlusion embolic protection

Carotid artery stenting has rapidly grown as an alternative to carotid endarterectomy for stroke prevention among selected patients with extracranial carotid artery stenosis. Development of mechanical embolic protection devices (EPDs) has been associated with improved clinical outcomes and is now a strongly advocated adjunct to the procedure. Characteristically, EPDs have been broadly defined into 3 primary categories, of which the distal filter elements have largely been the most developed and used. Improvements among the class of proximal balloon occlusion devices with flow reversal have a number of theoretic advantages and are the focus of this review article.     

Long-term follow-up of endoluminal grafting for aneurysmal and occlusive disease in the superficial femoral artery.

PURPOSE: To examine the long-term outcome of patients treated with endoluminal grafts (ELGs) for aneurysmal and occlusive disease in the femoropopliteal (FP) segment. METHODS: ELGs of radially expandable polytetrafluoroethylene with terminal Palmaz stents were used to form intimal conduits to revascularize lengthy occlusive disease and exclude aneurysms in the FP segment. Patient records were reviewed retrospectively for outcome. RESULTS: Fifty-five (98%) of 56 ELGs were placed successfully in 51 patients treated from August 1993 to February 1996. Over a mean 36-month follow-up, 28 (50%) ELGs occluded. Half of these failures reflected early technical difficulties. There were 11 (20%) stent stenoses, 6 in the proximal stent and 5 in the distal device. The majority of the graft failures were treated with endovascular techniques; however, FP bypass was required in 7 (25%) patients, while 2 (7%) were not treated. Life-table analysis demonstrated 46% primary and 68% secondary patency rates at 24 months. Among demographic and procedural variables, only previous dilation or stent procedures in the target artery was associated with failure (p < 0.0001). CONCLUSIONS: The prototype ELG used in this series demonstrated durability similar to conventional surgical therapy utilizing synthetic material. Endoluminal grafting of FP lesions may be a more durable alternative to classical bypass once devices and techniques are refined.     

Viabahn支架在处理股浅动脉支架内再狭窄中的初期应用经验

目的：探讨新一代人工血管支架Viabahn在股浅动脉支架再狭窄处理中应用的初期临床疗效。材料和方法：2013年4月收治的10例股浅动脉支架术后闭塞的患者,其中男6例,女4例,平均年龄68岁,所有病人均是近期患肢再发缺血症状．FortaineⅡb级6例,Ⅲ级4例,术前患肢踝肱指数（ABI）：0～0．48。所有病人术前CT血管造影成像（CTA）均提示股浅支架内再狭窄,其中完全闭塞9例。所有病人均再次行腔内治疗,10例患者均成功开通狭窄、闭塞的病变,先予球囊扩张,再植入Viabahn支架（直径5、6、7mm）,复后再扩张,所有lO例病人经过术后即刻造影评价血管通畅情况,术后当日测定ABI评价缺血改善情况．术后1周评价缺血等级改善,进而评价Viabahn的临床疗效。结果：所有10例病人成功的植入Viabahn支架15枚,技术成功率100％,无手术相关并发症出现。术后即刻造影结果：所有狭窄均消失,元残余狭窄存在。术后当日ABI测定O．76,0．96,较术前明显提高（t=-11．589,P=0．000）。术后1周Fortaine分级改善为：Ⅰ级7例,Ⅱa级3例。所有病例无任何操作相关的并发症出现。结论：Viabahn支架可以作为处理股浅动脉支架内再狭窄中一个安全、有效的选择。     

Effect of propranolol on the tone of collateral arteries in patients with occlusion of the superficial femoral artery

Summary. The effect of administration of 0·5 mg propranolol into the femoral artery in eight patients with lower limb ischaemia and superficial femoral artery occlusion on collateral arterial resistance was studied in supine and tilted head-up position. Mean blood pressures were recorded directly from the femoral and popliteal artery and femoral blood flow was measured by an indicator dilution technique. After β-receptor blockade in the supine position the collateral arterial resistance increased by 7±2%, femoral blood flow decreased 10±4%, and popliteal artery pressure increased by 4 mmHg (8±3%). During head-up tilt there was no change in femoral blood flow and collateral arterial resistance after propranolol. The peripheral vasoconstrictor effect of propranolol, therefore, seems not to be harmful to patients with vascular disease.