内膜下血管成形术治疗下肢动脉慢性长段硬化性闭塞疾病

目的 探讨内膜下血管成形术(SIA)在治疗髂、股动脉慢性长段硬化性闭塞疾病方面的临床效果和应用价值.资料与方法 2003年5月至2008年8月,49例髂、股动脉慢性长段硬化性闭塞患者,采用SIA进行经皮腔内血管球囊扩张(PTA)+内支架置入.结果 全组治疗成功率93.88%(46/49),24例髂动脉闭塞SIA后,随访3～48个月,血流均保持通畅;22例股浅动脉闭塞SIA后,随访3～36个月,血流仍保持通畅为20例(90.91%),2例股浅动脉支架置入后12个月出现再阻塞,经局部溶栓,支架腔内血流均保持通畅.术前术后平均踝肱指数(ABI)分别为0.23(0.11～0.42)和0.87(0.67～1.06),两者比较差异有统计学意义(P<0.05).结论 SIA在髂、股动脉慢性长段硬化性闭塞的PTA+内支架置入治疗中,可显著提高成功率,减少并发症,是安全有效的方法.     

X线导向下逆行腘动脉穿刺植入支架治疗股浅动脉闭塞症九例

目的 探讨X线导向下逆行腘动脉穿刺在股浅动脉闭塞介入治疗中的应用价值.方法 对9例股浅动脉长段闭塞患者采用经股动脉入路顺行开通受阻,改用X线导向下逆行腘动脉穿刺技术成功建立通路后,对闭塞段行球囊扩张及支架植入治疗.结果 9例患者腘动脉穿刺技术均获成功,闭塞段股动脉均获开通,间歇性跛行症状消失,未出现相邻神经、血管损伤...     

经腘动脉入路逆行治疗同侧股浅动脉近端狭窄和闭塞的临床应用

目的 探讨经腘动脉入路逆行治疗同侧股浅动脉近端狭窄和闭塞的临床效果和应用价值.方法 2008年1月至2011年6月收集15例下肢动脉狭窄闭塞患者,共计17条股浅动脉,右侧10条,左侧7条,病变段长度9 ～ 18 cm,平均(12.5 ± 6.8)cm,经腘动脉穿刺逆行治疗同侧股浅动脉近端狭窄和闭塞,采用经皮腔内血管成形...     

双向内膜下成形术在股浅动脉长段闭塞介入治疗中的应用

目的探讨双向内膜下成形术(SIA)在股浅动脉长段闭塞介入治疗中的临床价值。资料与方法采用股腘动脉双向内膜成形术治疗11例长段股浅动脉闭塞患者,术后复查踝肱指数并随访12个月。结果 11例患者股浅动脉闭塞段均开通,技术成功率100%,下肢缺血症状改善,复查踝肱指数0.74±0.26,与术前0.34±0.13比较明显升高(t=3.35,P<0.05);术后3个月、6个月和12个月支架通畅率分别为100%、90.9%和72.7%。结论股腘动脉双向内膜下成形术治疗长段股浅动脉闭塞成功率高,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。     

股腘动脉双通路介入治疗股浅动脉慢性完全闭塞

目的 评估仰卧位顺行再通失败后,股腘动脉双通路技术在股浅动脉慢性完全闭塞(CTO)中应用的安全性和临床意义.方法 收集2012年5月至2014年5月收治的顺行开通失败后改经腘动脉逆向穿刺并配合顺行开通术的股浅动脉CTO患者36例,术前均表现为间歇性跛行,其中11例有静息痛,5例足趾缺血性溃疡;股浅动脉平均闭塞长度为(88.4±5.6) mm,平均踝-肱指数(ABI)为0.52±0.12.手术均先采用经对侧股动脉穿刺顺行开通,失败后取仰卧位结合透视或路径图导引下经腘动脉逆行穿刺,导丝逆行通过闭塞段进入真腔后再作闭塞段球囊扩张及支架植入术.比较术前及术后1d、1个月、6个月、12个月患者症状及血管通畅率.结果 36例患者均通过股腘动脉双入路开通闭塞段动脉,共植入支架68枚,技术成功率100％.所有患者无穿刺点出血、血肿、假性动脉瘤、夹层、动静脉瘘、神经损伤等并发症,间歇性跛行症状均得到改善.术后1个月超声随访未出现支架内再狭窄,术后6个月有6例出现支架内再狭窄,但无明显症状;术后12个月27例中有13例支架内再狭窄,其中3例再次出现间歇性跛行,复查造影后予以球囊扩张,症状得到缓解.11例术前静息痛患者术后缓解,术后1、6个月随访中未再出现静息痛.5例足部溃疡患者中2例术后1个月内愈合,3例术后3个月内完全愈合.ABI由术前0.52±0.12改善至术后1 d 0.83±0.16(n=36,P＜0.05),术后1个月0.82±0.12(n=36,P＜0.05),术后6个月0.75±0.10(n=36,P＜0.05),术后12个月0.68±-0.13 (n=27,P＜0.05).结论 股浅动脉CTO患者仰卧体位下经股动脉顺行和腘动脉逆行开通闭塞段技术安全、有效,患者耐受性好,近期疗效确切,是股浅动脉CTO治疗的有效选择.     

内膜下成形术治疗股浅动脉长段闭塞

目的 探讨内膜下血管成形术(SIA)治疗长段股浅动脉闭塞的临床价值及中期随访结果.方法 采用SIA治疗45例临床表现为间歇性跛行和重症下肢缺血的长段股浅动脉闭塞患者,对中远期通畅率、保肢率及其影响因素进行统计学分析.结果 45例中,SIA成功治疗43例,其中36例经股浅动脉顺行成功再通,技术成功率为80.0%,另7例...     

准分子激光消蚀联合药物球囊治疗下肢动脉慢性缺血3例北大核心CSCD

目的分析准分子激光消蚀(ELA)联合药物球囊治疗下肢动脉慢性缺血的安全性和可行性。方法采用ELA联合紫杉醇涂层球囊治疗下肢动脉硬化闭塞症所致下肢动脉慢性缺血患者3例,均为股浅动脉段硬化闭塞病变,其中2例为原发闭塞性病变,1例为支架植入后再闭塞病变。结果 3例患者术后血流恢复通畅,下肢血运明显改善,无手术并发症。术后2周复查缺血症状均无复发,股浅动脉血流通畅,恢复顺利。结论 ELA联合紫杉醇涂层球囊治疗下肢动脉慢性缺血患者原发病变和支架再狭窄病变安全可行,远期随访结果尚需观察更多治疗患者。     

透视引导下远端动脉逆行开通技术在下肢动脉慢性闭塞性疾病中的应用

目的探讨常规顺行介入技术治疗下肢动脉慢性闭塞性病变失败时使用透视引导下逆行开通技术的安全性和有效性。方法回顾性分析15例股浅动脉长段和(或)腘动脉闭塞患者,经股动脉入路顺行开通失败时,在透视引导下用21 G穿刺针逆行穿刺远端动脉,以0.018英寸导丝配合支持导管通过闭塞段并超选择性插入近端导管,贯穿导丝后对病变行球囊扩张及支架植入治疗,比较治疗前后踝肱指数与经皮氧分压的变化。结果全部患者逆行穿刺技术均获成功,闭塞段股浅动脉、腘动脉均获开通,术后6个月踝肱指数与经皮氧分压较术前显著提高分别为(0.27±0.17)比(0.56±0.22),P=0.004,(19.0±4.2)mm Hg比(44.0±6.5)mm Hg(1 mm Hg=0.133 k Pa),P=0.001。未出现出血,动脉瘤,动静脉瘘,血栓形成等并发症,1例患者2个月后再发间歇性跛行症状。结论在顺行开通下肢动脉闭塞性病变失败时,透视引导下远端动脉逆行开通技术是一种高成功率与安全性的补救措施。     

周围动脉硬化闭塞性疾病腔内支架治疗

目的 探讨周围动脉闭塞性疾病(PAOD),腔内支架治疗临床效果和应用价值.方法 1995年5月至2008年5月,161例PAOD患者经皮经腔内支架置入治疗.结果 治疗成功率98.1%(158/161),127例下肢动脉硬化闭塞症(ASO)、术后踝肱指数(ABI)由术前平均0.35(0.11～58)增至0.87(0.67～1.06),两者比较差异有统计学意义(P<0.05).53例髂动脉和25例锁骨下动脉,内支架置入治疗后随访3～52个月,无一例临床症状复发.45例股浅动脉中、上2/3段阻塞,29例股浅动脉下1/3段和腘动脉阻塞,内支架置入治疗后6～52个月,血流保持通畅率分别为91.1%(41/45)和79.3%(23/29);9例肱动脉阻塞,支架置入治疗后随访时间超过3年,支架腔内血流均保持通畅.结论 经皮经腔内支架置人治疗PAOD是安全有效的方法,充分的局部溶栓治疗,可显著提高PrA和内支架置入的成功率,减少并发症.     

内膜下再通术在股腘动脉腔内成形术中的应用

目的 探讨内膜下再通技术(SIR)治疗股腘动脉粥样硬化闭塞病变的技术要点和疗效.方法 使用内膜下再通技术治疗患者股腘动脉完全闭塞病变42例.使用超滑导丝穿通闭塞段动脉内膜下腔,通过闭塞段后重新进入流出道真腔.建立闭塞段动脉内膜下通道后,用球囊腔内成形及支架置入以保证管腔通畅.结果 39例患者内膜下再通治疗获得成功,临床...     

Percutaneous transluminal angioplasty of the superficial femoral artery by retrograde catheterization via the popliteal artery

We report the results of 50 angioplasty procedures via the popliteal artery. A 3-year follow-up including control of blood pressures at ankle and toe levels show results comparable to reports in the literature. This new approach for angioplasty of the superficial femoral artery and eventually of coexisting iliac lesions enables treatment of previously inaccessible lesions. The technique is especially suited for lesions close to the takeoff of the superficial femoral artery.     

接力穿刺技术治疗无对侧股动脉入路的下肢动脉硬化闭塞症的应用研究

目的：研究接力穿刺技术治疗无对侧股动脉入路的下肢动脉硬化闭塞症患者的有效性和安全性。 方法：选取2014年4月—2017年9月入住我院的22例无对侧股动脉入路的下肢动脉硬化闭塞症患者,22例中对侧股动脉植入覆膜支架5例,主髂动脉病变已行对吻支架6例,主髂动脉病变同时累及双侧股动脉3例,腹主动脉瘤腔内修复术后4例,对侧截肢术后4例,采用接力穿刺技术（先肱动脉入路完成患侧髂股动脉病变治疗,获得患侧股动脉安全穿刺区,然后接力顺行穿刺患侧股动脉完成股腘动脉、甚至膝下动脉病变的腔内治疗）进行一期血运重建,治疗其下肢动脉硬化闭塞症,总结手术成功率及并发症情况。 结果：手术成功率为100%,共植入103枚支架,平均4.7枚/人。所有缺血症状术后立即得到缓解,患肢踝肱指数（ABI）显著提高[（0.90±0.16）vs.（0.33±0.18）,t=18.80,P<0.01）。随访2~36月(平均19.5个月),围手术期及随访期间无严重手术相关并发症,术后1年的一期通畅率为81.8%（18/22）。 结论：应用接力穿刺技术治疗无对侧股动脉入路、肱动脉入路腔内器械过短无法完成血运重建的下肢动脉硬化闭塞症是安全、有效的,可以作为首选治疗方法。     

Ultrasound assessment of atherosclerotic vessel wall changes: reproducibility of intima-media thickness measurements in carotid and femoral arteries

RATIONALE AND OBJECTIVES: Ultrasonography is widely used in cardiovascular research to quantify early atherosclerotic vessel wall changes. In this article, we examined the short- and long-term reproducibility of this technique in the common carotid artery, carotid bifurcation, common femoral artery, and superficial femoral artery. Furthermore, we assessed the effect of progressed atherosclerosis on reproducibility. METHODS: Repeated ultrasound examinations were performed by one observer on 15 healthy individuals and 18 patients suffering from coronary heart disease. Intima-media thickness was determined by B-mode ultrasonography. The examinations were repeated by the same observer after a short time interval (short-term) and after a few weeks (long-term) and expressed as the mean difference between the measurements and the coefficient of variation (CV). RESULTS: The reproducibility of the intima-media thickness determination turned out to be best in the common carotid artery and the superficial femoral artery when performed in healthy controls (CV 5.6% and 5.5%, respectively). Reproducibility was less in patients with clinical atherosclerosis; this especially affected the reliability of the superficial femoral artery measurement (CV in healthy controls was 5.5%; in coronary heart disease patients, 17.5 %). The reliability of the intima-media thickness measurements in the common carotid artery (CV in healthy controls was 5.6%; in coronary heart disease patients, 9.5%) proved to be least affected by progressed atherosclerosis. A longer time interval between measurements did not affect the reproducibility of intima-media thickness measurements in healthy controls, whereas in the patients it led to some decrease of reproducibility and to a major decrease in reproducibility of the superficial femoral artery measurements (CV changed from 12.7% to 17.5%). CONCLUSIONS: Ultrasonography is a reliable and accurate technique to determine intima-media thickness in superficial arteries. In studies in which the intima-media thickness determination is used as a marker for generalized and coronary atherosclerosis, the common carotid artery should always be included, whereas the benefit of inclusion of other arteries depends on age and the expected extent of atherosclerosis in the individuals studied.     

Percutaneous femoral artery puncture: practice and anatomy

In a survey of the superficial landmarks used to select the site of puncture of the femoral artery for angiography, the inguinal skin crease was most popular, preferred by 39.2% of angiographers. The maximal femoral pulse irrespective of the position of the skin crease was the next most popular landmark (24.7%). Bony landmarks were least popular (13.0%). The majority (73.7%) of those using the skin crease punctured at the same level or distal to it. The relationship of these superficial landmarks to the common femoral artery (CFA) and its bifurcation were investigated. The inguinal skin crease was distal to the bifurcation of the CFA in 71.9% of limbs (mean, 0.61 cm). The maximal femoral pulse was over the CFA in 92.7% of limbs, and the CFA was projected over the medial aspect of the femoral head in 77.9% of limbs. The use of the inguinal skin crease is a popular though unreliable guide for puncture of the CFA. Use of the maximal femoral pulse will enable more constant puncture of the CFA.     

经桡动脉路径椎动脉支架成形术的临床研究

目的评价经桡动脉行椎动脉支架成形术的安全性及有效性,主要优缺点及适应证、禁忌证,并探讨其技术要点。方法对36例不适合经股动脉路径行椎动脉支架成形术或不愿意术后卧床的患者进行经桡动脉椎动脉支架成形术(桡动脉组),统计其穿刺成功率、手术成功率及并发症发生率;并与同期52例经股动脉椎动脉支架成形术(股动脉组)结果进行比较。结果穿刺成功率、手术成功率及并发症发生率在桡动脉组分别为97.2%(35/36)、88.9%(32/36)、5.6%(2/36),股动脉组分别为98.1%(51/52)、96.2%(50/52)、26.9%(14/52)。两组间穿刺成功率、手术成功率差异无统计学意义(χ2=0.09378,0.8087,P值均>0.05);但并发症发生率两组间差异有统计学意义(χ2=5.17,P<0.05)。桡动脉组患者发生穿刺部位轻微淤血2例,无血肿、假性动脉瘤和动静脉瘘等严重并发症发生。结论经桡动脉椎动脉支架成形术安全有效,并发症发生率低,可作为椎动脉支架成形术的选择途径之一。     

股腘动脉支架断裂与支架内再狭窄相关性分析

目的 探讨股腘动脉硬化闭塞性病变接受支架植入患者术后发生支架内再狭窄(ISR)与支架断裂的相关性.方法 回顾性随访分析2012年3月至2016年3月采用股浅动脉及近段腘动脉支架一期植入术治疗股腘动脉硬化闭塞性病变患者97例(107条患肢).通过彩色多普勒超声、X线平片、增强CT及DSA造影等检查采集影像学资料,采用Kaplan-Meier生存分析等统计分析相关资料.结果 随访期内71例患者(72条患肢)发生ISR,发生率为67.3％(72/107).支架断裂组、未断裂组ISR发生率分别为84.2％(32/38)、58.0％(40/69),差异有显著统计学意义(P=0.01).结论 股腘动脉支架植入后支架断裂是导致ISR的重要危险因素之一.     

Antegrade catheterization of the superficial femoral artery

A simple method of selective catheterization of the superficial femoral artery (SFA) following antegrade puncture of the common femoral artery is described. The method entails using a Cope-type dilator introducer, which directs the guide wire from its side hole into the SFA while the tip is secured in the deep femoral artery.     

Stenting in the femoral superficial artery: an overview.

Stenting in the superficial femoral artery is still a controversial treatment in case of occlusive disease. Although the results of percutaneous treatment especially in the Hunter canal region are moderate, balloon angioplasty is nowadays an established technique. Many investigators tried to improve their results with additional stenting of the superficial femoral arteries after inappropriate results of balloon angioplasty and/or stenting. Although the figures of results after stenting are not consistent in literature even when using stent graft material I still feel that especially in the superficial femoral artery stenting procedures should not be performed on a routine basis. The main issue in stent failure is the extensive intima hyperplasia. Many investigators are working on this problem but as long as no real solution is available I feel that we have to act reluctantly in treating superficial femoral arteries with stents.     

主-髂-股动脉闭塞性病变介入治疗的技术探讨及疗效观察

目的探讨主-髂-股动脉闭塞性病变介入治疗的技术要点。方法本组34例主-髂-股动脉闭塞的患者中，腹主动脉下段、双侧髂动脉完全闭塞8例，同时肾动脉受累3例；单侧髂动脉闭塞23例，其中病变累及股总动脉4例；单纯单侧股浅动脉长段闭塞3例。分别行闭塞段开通、经导管局部溶栓、血管腔内成形术(PTA)和内支架置人等多种介入方法综合治疗。结果除3例髂动脉闭塞未能开通外，8条腹主动脉，36条髂动脉，4条股总动脉和3条股浅动脉均得以开通，开通率为94％。共置入裸支架46枚，覆膜支架3枚。其中包括腹主动脉支架6枚，髂动脉支架34枚，股总动脉支架2枚、股浅动脉支架4枚和肾动脉支架3枚。在治疗成功的31例中，9例临床症状和体征得到缓解，21例明显改善，1例因长期慢性肾功能衰竭于术后第2天死亡；其中4例合并有并发症。术后平均随访21．5个月(2～53个月)，除2例分别在术后2个月和14个月发生支架内再闭塞行二次介入治疗外，其余患者症状均无加重或复发。结论综合应用多种介入方法治疗主-髂-股动脉闭塞性病变是一项安全有效的治疗手段，可获得满意的临床效果。