动脉硬化闭塞症膝下动脉血管腔内治疗的近远期疗效观察

目的:观察动脉硬化闭塞症膝下动脉病变经皮血管腔内治疗的疗效。方法:选取我科2006年10月至2009年10月期间,动脉硬化闭塞症膝下动脉病变经皮血管腔内治疗的117例患者,回顾性分析腔内治疗开通血管的成功率及术后随访资料。结果:117例患者(132条患肢)初次腔内治疗成功率为90.15%(119/132)。术后平均随访18个月(4～36个月)。血管再狭窄发生率分别为:6个月8.5%(10/117),12个月19.0%(22/116),18个月25.9%(30/116)。21例临床症状复发,再次腔内治疗成功率85.7%(18/21)。患者手术后间歇性跛行、静息痛、缺血性溃疡等临床症状均明显改善。结论:动脉硬化闭塞症膝下动脉腔内治疗手术成功率较高,临床效果满意,远期有一定的复发率,但可再次治疗。     

经皮腔内血管成形术治疗膝下动脉硬化闭塞症临床研究

目的探讨经皮腔内血管成形术（PTA）对膝下动脉硬化闭塞症的治疗效果。方法回顾性分析我院从2006年10月~2008年5月采用PTA治疗膝下动脉硬化闭塞症的18例患者（22条肢体）病史资料和术后随访资料。结果20条肢体获得影像学成功,技术成功率90.9%;治疗后第1周踝/肱指数较术前增加（P〈0.05）;术后6、12个月肢体通畅率分别为81.8%和63.6%,术后12个月肢体保全率和存活率分别为90.9%、95.5%。结论PTA是安全有效的治疗膝下动脉硬化闭塞症的方法。     

膝下动脉闭塞腔内治疗与手术治疗效果的临床分析

目的:评价膝下动脉闭塞球囊扩张成形术和动脉旁路术的治疗效果。方法:回顾性分析2005年12月至2009年5月北京协和医院收治的膝下动脉闭塞重症下肢缺血病例,全部资料都是前瞻性收集并录入数据库,并将治疗结果进行回顾性分析。根据膝下动脉初次处理手段的不同分为2组:球囊扩张成形术(PTA)组、以膝下动脉为流出道行自体静脉旁路移植术(bypass surgery,BPS)组,比较2组手术及随访结果。结果:PTA组54例(61条肢体),男性37例,女性17例,平均年龄66岁;手术前后踝肱指数(ABI)由(0.43±0.27)增加至(0.86±0.21),随访期间一期通畅率63.8%,二期通畅率74.1%,救肢率88.3%。动脉旁路术组17例(17条肢体),男性12例,女性5例,平均年龄67岁,ABI由(0.21±0.19)增加至(0.73±0.38),手术通畅率60%,救肢率87.5%。2组治疗结果差异无统计学意义。结论:膝下动脉腔内成形术的临床治疗效果不次于膝下动脉旁路手术,可以作为膝下动脉闭塞首选的治疗方法。     

经皮腔内血管成形术联合血管内支架治疗老年下肢动脉硬化闭塞症患者的疗效

目的探讨经皮腔内血管成形术(PTA)联合血管内支架治疗老年下肢动脉硬化闭塞症(ASO)的临床疗效。方法收集28例老年患者、31条肢体,共53处病变部位行血管形成术联合支架植入术(PTAS)进行治疗,术后1个月对患者的跛行距离及踝肱指数进行监测,同时对术后病变部位的血管通畅率进行随访。结果行PTAS手术后,髂动脉的成功率为100%,股腘动脉的成功率为95.24%;术后1个月,患者的踝肱指数由术前的(0.35±0.11)增加至术后的(0.95±0.09),间歇性跛行距离由术前的(117.3±29.9)m增加至术后的(518.4±122.7)m,手术前、后比较差异显著(P0.05);术后2年髂动脉的血管通畅率为91.67%,股腘动脉的血管通畅率为80.95%。结论 PTA联合PTAS治疗下肢动脉ASO手术成功率高、创伤性小、安全有效,且能有效改善缺血区的血液供应,再狭窄可能性减小。     

膝下动脉闭塞性病变支架置入治疗的研究

目的:观察应用支架置入术治疗下肢膝下动脉闭塞性病变的近期疗效,初步总结其技术方法与治疗经验。方法:选择2010年10月至2012年5月期间,西苑医院收治的存在膝下动脉狭窄闭塞性病变的72例(86条肢体)动脉硬化闭塞症患者,采取股动脉顺行穿刺,开通并球囊扩张病变段膝下动脉,其后对患肢的膝下段病变进行了补救性支架置入治疗。结果:该组72例患者(86条肢体)术后即刻造影显示全部支架血流通畅,技术成功率达100%;术后68例患者(82条肢体)临床症状体征明显改善,临床成功率94.4%。术后6个月随访保肢率98.6%。结论:支架置入术作为补救措施治疗下肢动脉硬化闭塞症的膝下段动脉病变具有较高的可行性,近期疗效满意。     

球囊经皮腔内血管成形术治疗糖尿病肢体动脉硬化闭塞症15例报告

糖尿病足患者经皮胫腓动脉腔内成形术（PTA）后随访3～12个月显示：15例（17条腿）术后临床动脉影像达100％成功。1例于3个月后截肢,其余病例临床疗效满意。3个月动脉开放率达94％。结论是：PTA对胫腓动脉阻塞的DM患者具有临床应用价值。     

症状性锁骨下动脉狭窄或闭塞的腔内治疗效果分析

目的 探讨症状性锁骨下动脉窃血综合征患者血管腔内技术治疗的临床有效性和安全性。方法 选取首都医科大学附属北京朝阳医院血管外科2011年1月至2015年8月收治的症状性锁骨下动脉狭窄或闭塞患者38例,其中男27例,女11例;平均年龄为（66.2±10.8）岁。患者均表现为头晕等神经系统症状,部分合并上肢缺血症状。运用血管腔内技术,对锁骨下动脉进行球囊扩张成形及支架植入术。结果 36例患者均成功植入球扩式支架,术后双上肢收缩压差显著改善,神经系统症状消失或改善33例,无效2例,1例术中发生脑梗死,经康复锻炼后好转;2例操作没成功,保守治疗。随访期间再狭窄3例,支架断裂1例。结论 严格掌握适应证,采用腔内技术治疗锁骨下动脉狭窄或闭塞的神经系统症状安全有效,操作简单。     

顺行穿刺腔内治疗下肢动脉硬化闭塞症的疗效评估

目的 评估顺行穿刺腔内治疗在下肢动脉硬化闭塞症中的应用价值及疗效.方法 回顾性分析2008年1月至2012年1月接受腔内血管成形术(PTA)和(或)血管支架置入治疗的患者119例,随访6个月～3年.对术前及术后的Fontaine分期,踝肱指数(ABI)等资料进行分析比较.结果 手术成功率为82.4％(98/119),FontaineⅡ期组58例,成功率为91.3％(53/58),45例临床症状得到改善,缓解率84.9％(45/53);Ⅲ期组为81.1％(30/37)和90.0％(27/30),Ⅳ期组为62.5％(15/24)和60.0％(9/15).Ⅱ期组技术成功率明显高于Ⅲ期及Ⅳ期组(P＜0.03);Ⅲ期组的临床症状缓解率高于Ⅱ期及Ⅳ期组(P＜0.05).踝肱指数(ABI)由术前的0.39±0.17提升至术后0.73 ±0.14(P ＜0.01).技术成功患者的随访率为78.7％(85/108),术后第3、6、12、24、36个月分别有3例、6例、10例、7例、5例复发,其中17例再次行分入治疗后临床症状好转;随访期间行截肢/足手术患者6例,截肢率5.6％(6/108).其中截肢平面在膝关节以上2例,膝下平面截肢1例,3例行跖骨截除.结论下肢动脉硬化闭塞症患者血管腔内治疗是安全、有效的,能改善患者的临床症状.近期及中期疗效较满意,远期疗效有待进一步随访.     

复合手术治疗高龄下肢动脉硬化性闭塞症32例

下肢动脉硬化性闭塞症是动脉粥样硬化累及下肢动脉导致动脉狭窄或闭塞而引起肢体缺血症状的慢性疾病,患者多为高龄,且多合并高血压、高脂血症、糖尿病,以及不同程度的冠状动脉粥样硬化,治疗上较为棘手。我院血管外科于2005年4月至2010年4月,采用7种复合(杂交)手术方式处理32例高龄、多节段、复杂下肢动脉硬化闭塞症患者,取得较好疗效。     

髂动脉至股深动脉腔内成形术治疗下肢动脉硬化闭塞症患者效果及并发症

<正>下肢动脉硬化闭塞症(LEASD)是一种以下肢麻木、发冷、疼痛、间歇性跛行为主要表现的退行性病变,其也是导致老年人下肢缺血的主要原因,若得不到及时、有效的治疗,很容易引起残疾甚至截肢〔1〕。LEASD是因动脉内形成粥样硬化斑块而引起的下肢动脉狭窄、阻塞,好发于小腿动脉、股浅动脉、髂动脉等〔2〕。开放性手术逐渐被血管腔内修复手术所替代,介入治疗已成为了目前临床治疗LEASD的主要手段。本文分析髂动     

腔内治疗下肢动脉硬化闭塞症的可行性和效果

目的 探讨下肢动脉硬化闭塞症（ASO）腔内治疗的方法及疗效。方法 回顾性地分析2009年6月至2013年6月保定市第二医院血管外科收治的132例（136条肢体）行腔内治疗的下肢ASO患者的临床资料及随访情况。结果 技术成功率为98.5%（134/136）,并发症发生率为5.30%（7/132）,无围术期死亡。术后踝肱指数（ABI）显著高于术前,差异具有统计学意义（0.84±0.15 vs 0.45±0.13,P＜0.001）。术后6,12,24个月肢体1期通畅率分别为93.28%（125/134）、88.06%（118/134）和65.91%（87/132）;术后12和24个月肢体累积2期通畅率分别为92.54%（124/134）和68.94%（91/132）。术后24个月肢体保全率为100.00%（132/132）。结论 腔内治疗下肢ASO成功率高、并发症少。     

TASC C型股浅动脉闭塞病变腔内治疗的临床分析

目的 观察泛大西洋协作组织共识（TASC）C型股浅动脉闭塞（或狭窄＞70%）腔内治疗效果及随访1年结果,分析支架内再狭窄（ISR）的相关因素。方法 回顾首都医科大学附属北京天坛医院普通外科2011年5月至2014年5月期间收治的患下肢动脉硬化闭塞症TASC C型的患者58例（58条肢体）。手术方法为血管腔内球囊扩张＋支架置入术。术后1年随访是否有支架内再闭塞或狭窄（＞70%）。根据是否发生支架内再闭塞或狭窄（＞70%）,将患者分为通畅组及再闭塞组,分析比较两组患者的临床资料。结果 58例患者无围术期死亡。58条肢体中有6条未能开通,腔内治疗开通率为89.7%。1年后完成随访41例,通畅组30例,再闭塞组11例。两组患者踝肱指数相比差异具有统计学意义[（0.55±0.16） vs （0.41±0.24）,P＜0.05]。两组患者的吸烟者比例和Fontaine分期虽无显著性差异,但P值相对较低,提示二者也可能与术后ISR相关。结论 腔内治疗TASC C型股浅动脉闭塞安全有效,血管病变严重程度与ISR相关。     

Clinical results of percutaneous transluminal angioplasty for thromboangiitis obliterans in arteries above the knee

Objective

This study was designed to retrospectively investigate whether percutaneous transluminal angioplasty (PTA) is efficacious and safe for the treatment of atypical thromboangiitis obliterans (ATAO) in arteries with occlusion of long segments.

Methods

From January 2011 to July 2013, 9 consecutive male patients with ATAO involving the external iliac and superficial femoral arteries were treated by PTA alone, without stent placement. Their mean age was 35 years (range, 24–47 years). Preoperative symptoms included severe claudication (n = 2), ischemic pain at rest (n = 4), and ischemic ulcers (n = 3). No any infrapopliteal interventions were performed besides the proximal intervention.

Results

Technical success using PTA was achieved in 100% of cases with occluded arteries, and there were no periprocedural complications. Clinical improvement was observed postoperatively with a significant improvement in Rutherford categories (range, 2–3) and significantly increased ankle-brachial indexes, from 0.59 ± 0.14 to 0.91 ± 0.17 (p < 0.01). Ischemic ulcers in three patients healed 3–5 months postoperatively. No recurrent ischemic ulcer was observed, and no amputation was performed in these patients. At follow-up examination (average, 20.9 months), restenosis of the superficial femoral artery was diagnosed in only one patient who continued with a conservative medication regimen and refused additional interventional treatment because his physical symptoms were minor.

Conclusion

PTA might be feasible and safe for the treatment of ATAO patients, and appears to provide positive clinical results at an average follow-up of 20.9 months.     

腔内隔绝术治疗主动脉瘤23例疗效观察

目的:探讨腔内隔绝术治疗主动脉瘤的疗效.方法 回顾性分析23例经腔内隔绝术治疗主动脉瘤患者的一般临床资料、手术情况、手术结果和术后随访情况.结果 23例患者均手术成功,术后造影见主动脉瘤体(或夹层假腔)消失,支架无移位,无发牛截瘫;1例术后18 h突发脑血管意外抢救无效死亡,总治愈率为95.7%(22/23).术后并发症主要为内漏,其中Ⅰ型内漏3例,Ⅱ型内漏2例,发生率为21.7%(5/23),急性肾功能不全4例(17.4%);脑卒中1例,发生牢为4.3%(1/23).随访4个月～60个月,2例失访.随访期间死亡2例.死亡原因1例为恶性肿瘤转移,另1例为复发性降主动脉夹层破裂大出血;随访期经复查,5例早期并发内漏者内漏消失,假腔血栓形成.结论 腔内隔绝术治疗主动脉瘤安全而且有效.     

Endovascular intervention of aortoiliac occlusive disease in high-risk patients using the kissing stents technique: long-term results.

Endovascular intervention deploying a kissing stents (KS) technique has been used as an alternative to surgical intervention in treating symptomatic aortoiliac occlusive disease. However, the long-term results on high-risk patients are unknown. We retrospectively analyzed data on high-risk patients who underwent endovascular intervention using the KS technique at our institution. Fifty high-risk patients aged 62 +/- 6.4 years with severe aortoiliac stenosis underwent stent-supported angioplasty using the KS technique. Thirty percent of the patients had total occlusion of the distal aorta and/or the iliac arteries. Twelve patients received thrombolytics prior to stenting. The procedure was successful in all 50 patients. There was a 4% acute complication rate (distal embolization). However, there were no vascular complications, myocardial infarction, or perioperative death. Primary patency during follow-up of 20 +/- 12.3 months was 92%, while secondary patency rate was 100%. Amputation-free survival was 100%. Ninety-two percent remained free of lifestyle-limiting claudication.     

A prospective,multi‐center study of the chocolate balloon in femoropopliteal peripheral artery disease: The Chocolate BAR registry

The Chocolate BAR study is a prospective multicenter post‐market registry designed to evaluate the safety and performance of the Chocolate percutaneous transluminal angioplasty balloon catheter in a broad population with symptomatic peripheral arterial disease. The primary endpoint is acute procedural success (defined as ≤30% residual stenosis without flow‐limiting dissection); secondary long‐term outcomes include freedom from target lesion revascularization (TLR), major unplanned amputation, survival, and patency. A total of 262 patients (290 femoropopliteal lesions) were enrolled at 30 US centers between 2012 and 2014. The primary endpoint of procedure success was achieved in 85.1% of cases, and freedom from stenting occurred in 93.1%. Bail out stenting by independent adjudication occurred in 1.6% of cases and there were no flow limiting dissections. There was mean improvement of 2.1 Rutherford classes (±1.5) at 12‐months, with 78.5% freedom from TLR, 97.2% freedom from major amputation, and 93.3% freedom from all‐cause mortality. Core Lab adjudicated patency was 64.1% at 12 months. Use of the Chocolate balloon in an “all‐comers” population achieved excellent procedural outcomes with low dissection rates and bailout stent use.     

Extensive use of peripheral angioplasty,particularly infrapopliteal,in the treatment of ischaemic diabetic foot ulcers: clinical results of a multicentric study of 221 consecutive diabetic subjects

OBJECTIVE: To evaluate the feasibility, technical effectiveness and limb salvage potential of percutaneous transluminal angioplasty (PTA), particularly infrapopliteal, in diabetic subjects with ischaemic foot ulcer. DESIGN: Intervention study with PTA in consecutive series. SETTING: Six Diabetology Foot Centres and one Cardiovascular Catheterization Laboratory in Italy. SUBJECTS: Two hundred and twenty-one consecutive diabetic subjects hospitalized for ischaemic foot ulcer. INTERVENTION: Peripheral arterial occlusive disease (PAOD) was investigated by means of foot pulses assessment, ankle-brachial-index (ABI), transcutaneous oxygen tension (TcPO2) and duplex scanning. If non-invasive parameters suggested PAOD, angiography was performed and a PTA was carried out during the same session. MAIN OUTCOME MEASURES: PTA feasibility, improvement of ABI and TcPO2, limb salvage rate, clinical recurrence. RESULTS: On angiography, two patients had stenoses which were <50% of the vessel diameter. PTA was performed in 191 (85.3%) of the 219 subjects with stenoses >50%, even when longer than 10 cm and/or multiple/calcified. In 11 patients (5.8%) PTA was performed in the proximal axis exclusively, in 81 (42.4%) patients in the infrapopliteal axis exclusively and in 99 (51.8%) in both the femoropopliteal and infrapopliteal axis. Both ABI and TcPO2 improved significantly after PTA (P < 0.0001). Clinical recurrence occurred in 14 subjects: 10 of whom underwent a second successful PTA. Of the 191 patients who underwent PTA, 10 (5.2%) underwent an above-the-ankle amputation. CONCLUSIONS: PTA, including infrapopliteal, is feasible in most diabetic subjects with ischaemic foot ulcer and is effective for foot revascularization. Clinical recurrence was infrequent and the procedure could successfully be repeated in most cases. In subjects treated successfully with PTA the above-the-ankle amputation rate was low. PTA should be considered as the revascularization treatment of first choice in all diabetic subjects with foot ulcer and PAOD.     

血管介入术治疗老年下肢动脉硬化闭塞症的疗效及安全性分析

目的探讨血管介入术治疗老年下肢动脉硬化闭塞症(LEAOD)的疗效及安全性。方法回顾性分析2014年7月至2015年12月在赤峰市医院血管外科行腔内血管成形术(PTA)治疗的120例(146条肢体)老年LEAOD患者的临床及随访资料,记录其临床症状缓解情况及并发症的发生率。采用SPSS 17.0软件进行数据处理。依据数据类型,组间比较分别采用t检验或χ~2检验。结果介入成功率为97.95%(143/146),无死亡病例。与治疗前相比,患者治疗后的足背动脉内径[(1.16±0.32)vs(1.34±0.33)mm]、血流量[(0.52±0.12)vs(0.66±0.13)ml/(s·mm2)]、踝肱指数(ABI)[(0.36±0.11)vs(0.65±0.08)]、跛行距离[(34.53±8.72)vs(633.78±32.56)m]及皮肤温度[(30.03±0.91)℃vs(33.56±3.45)℃]显著增高,而血流峰值[(51.31±7.85)vs(41.51±6.82)cm/s]和视觉模拟评分量表[(7.12±1.95)vs(0.65±0.12)分]显著降低,差异均具有统计学意义(P0.05)。术后24个月肢体保全率为100.0%(143/143),无死亡病例。发生再狭窄或闭塞者48例(50条肢体),发生率为35.0%(50/143),其中8例需再次行PTA。结论血管介入术治疗老年LEAOD患者疗效显著,安全性高。     

老年周围动脉疾病综合介入治疗的临床观察

目的　探讨综合介入治疗老年周围动脉疾病的临床疗效及安全性。方法　采用经皮穿刺周围动脉血管球囊扩张术 (PTA)、支架置入、持续动脉内溶栓加PTA、血管内膜剥离术加支架置入术等综合介入方法治疗老年周围动脉阻塞性病变 6 2例次 ,其中上肢锁骨下动脉阻塞性病变 2 1例次 ,下肢动脉病变 4 1例次。单纯PTA 6例次 ,球囊预扩张加支架置入术 5 2例次 ,溶栓加PTA 3例次 ,股动脉内膜剥离术加髂动脉支架置入术 1例。结果　手术成功率95 % ,手术并发症 1.4 % (支架脱落 1例 )。术后即刻血管造影影像学和临床表现明显改善。随访 3个月～ 2年 ,无复发性肢体缺血症状生存 6 7% ,间歇性跛行较术前减轻并维持 13% ,临床再狭窄率 2 0 %。结论　老年周围动脉阻塞性病变综合介入治疗近、远期疗效满意 ,手术安全可靠 ,肢体复发性缺血症状发生率相对较低 ,是目前治疗老年周围动脉疾病的有效方法之一