股深动脉血流重建治疗重症下肢动脉硬化闭塞症

目的 总结股深动脉血流重建治疗下肢动脉硬化闭塞症的经验.方法 选择Fontaine Ⅲ、Ⅳ期下肢动脉硬化闭塞症患者22例.根据病情选择的术式包括腹主动脉-股总或股深动脉人工血管旁路移植术、股-股总或股深动脉人工血管旁路移植术、髂动脉球囊扩张加支架植入术、单纯股总或股深动脉成形术、杂交手术或股总-股深动脉球囊扩张及支架植入术等.结果 22例患者中,行腹主动脉-股总或股深动脉人工血管旁路移植术5例,股-股总或股深动脉人工血管旁路移植术3例,髂动脉球囊扩张加支架植入术7例(其中3例加做股总或股深动脉成形术),单纯股总或股深动脉成形术4例,股总-股深动脉球囊扩张,支架植入术1例.2例患者髂动脉全程闭塞,采取杂交手术治疗.Fontaine Ⅲ期患者14例术后全部静息痛消失;Fontaine Ⅳ期患者7例静息痛消失,1例无效,术后行膝上截肢手术.4例患者行截足(趾)术后愈合,3例溃疡换药治疗后愈合.结论 当髂股动脉或股浅动脉广泛闭塞时,股深动脉作为流出道,对重建下肢血流、挽救肢体,降低截肢平面起到至关重要的作用.     

1例下肢动脉硬化闭塞症合并糖尿病高血压行腋—股动脉人工血管转流术的护理

下肢动脉硬化闭塞症（ASO）是由腹主动脉末端至下肢动脉发生动脉粥样硬化,引起硬化管腔不同程度狭窄、闭塞而造成肢体急慢性缺血的综合征.目前重建血供的主要治疗措施足血管重建术.当患者合并有心血管、脑血管等全身血管性疾病及糖尿病时,会极大的增大手术风险并影响愈后.我院1月为1例左股动脉闭塞、双侧髂总动脉血栓形成合并糖尿病及高血压的患者实施了右腋一双股动脉人工血管转流术＋左髂外动脉取栓术＂,经精心的护理患者康复出院.现将护理体会总结如下.     

髂动脉狭窄闭塞的外科处理

目的 探讨髂动脉狭窄闭塞外科治疗的适应证和方式.方法 2000年7月～2008年3月治疗髂动脉闭塞症患者111例(145条肢体),其中主-股转流13例,腋-股转流17例,股-股转流30例,髂动脉内膜剥脱成形13例,髂动脉取栓12例,髂动脉扩张支架(腔内介入治疗)46例,部分病例为腔内介入治疗和髂动脉取栓、股-股转流的杂交复合手术.结果 治疗均获成功,无手术死亡.踝/肱指数由术前的平均0.37上升至0.63.2例腋-股转流、4例股-股转流因人工血管闭塞而再次行重建手术获得成功.结论 髂动脉闭塞的治疗因综合患者的局部条件和全身条件而决定,解剖位转流具有较高的远期通畅率.腔内介入治疗越来越受到重视,其与传统术式的结合正成为一种趋势.     

血管腔内旋切治疗下肢动脉硬化闭塞症的护理

动脉硬化闭塞症为动脉粥样硬化病变引起的慢性动脉闭塞性疾病,大多发生于50岁以上的老年人,且多伴有高血压、冠心病.此病主要侵犯主动脉下段、髂动脉、股动脉等大中动脉,造成下肢严重的缺血症状.     

下肢动脉闭塞症的手术配合

动脉硬化闭塞症(ASO)为动脉粥样硬化病变引起的慢性动脉闭塞性疾病，主要侵犯腹主动脉下端、髂动脉、股动脉等大中型动脉。由于动脉粥样硬化斑块、动脉中层变性和间断发生的血栓形成而逐渐形成管腔闭塞，使下肢供血减少或缺血。临床以肢体发凉、间歇性跛行、疼痛、缺血性坏死等为表现。本院于2002～2003年手术治疗下肢动脉硬化闭塞症38例。现将手术配合总结如下。     

髂动脉支架联合人工血管转流术治疗下肢动脉硬化闭塞症的效果

目的探讨髂动脉支架联合人工血管转流术治疗下肢动脉硬化闭塞症的效果,以供临床参考。方法选择2010年5月至2012年4月我院下肢动脉硬化闭塞症患者42例作为研究对象,均接受髂动脉支架联合人工血管转流术治疗,观察治疗效果和手术并发症,对比治疗前后踝/肱指数(ABI)的差异性。结果术后患者达到显效22例,有效18例,无效2例,总有效率为95.24%。术后发生感染2例,术肢肿胀5例,手术并发症发生率为16.67%。经对症处理后均痊愈。与治疗前比较,患者治疗后ABI明显上升,差异具有统计学意义(P<0.05)。结论采用髂动脉支架联合人工血管转流术治疗下肢动脉硬化闭塞症疗效满意,值得在临床工作中推广应用。     

腹主动脉末端阻塞30例诊断与治疗

目的　探讨腹主动脉末端阻塞的诊断和治疗方法及预后。方法　回顾分析 1998- 2 0 0 0年共收治的 30例患者的临床资料、诊断手段、手术方式。结果　以腹主动脉—双髂动脉 Y型人工血管移植效果最佳 ,1、5 a通畅率分别为 10 0 %、6 2 %。死亡 3例中 ,1例死于术后出现肾功能衰竭 ,1例死于肺部感染至多器官功能衰竭 ,另1例术后高血钾心律失常导致死亡。结论　早期诊断、选择合理的术式、成功的血管重建、果断的筋膜切开 ,可减少病残率及病死率     

多层螺旋CT血管成像对下肢动脉疾病的诊断作用探讨

目的探究在下肢动脉疾病诊断中多层螺旋CT血管成像的应用价值。方法选取在2013年2月至2015年2月期间我院收治的下肢动脉疾病患者88例,所有患者均采用多层螺旋CT血管成像进行检查,与原始图像相结合,并用多种处理方法进行分析,主要方法包括的内容为最大密度投影、容积再现、高级血管分析及曲面重建等。结果多层螺旋CT血管成像能将股动脉、髂内外动脉、髂总动脉、腹主动脉及胫腓动脉分支和主干显现出来。其中有65例患者有动脉粥样硬化、闭塞及狭窄的情况,5例为动脉瘤,6例为下肢搭桥术,2例为动脉血栓,1例为大动脉炎,1例为动静脉瘘,3例为夹层,5例为正常表现。并应用DSA对所有患者进行诊断。经对比,多层螺旋CT血管成像对诊断下肢闭塞和狭窄的准确性及敏感性较高。结论在下肢动脉疾病的诊断中应用多层螺旋CT血管成像有较高的诊断价值,值得在临床诊断中推广应用。     

下肢动脉硬化闭塞采取原位大隐静脉旁路术治疗的效果研究

目的 探讨原位大隐静脉旁路术治疗下肢动脉硬化闭塞的临床效果.方法 随机性的抽取了55 例运用自制瓣膜切除器进行原位大隐静脉动脉旁路手术治疗下肢动脉硬化闭塞的患者,一共57 条肢体.回顾性分析了所有患者的治疗方法、治疗效果以及体会.结果 踝肱指数由术前的0.42 增加到0.85.23 例严重缺血肢体患者的踝肱指数的平均值由术前的0.26 恢复到0.78,严重缺血肢体的挽救率为100%.全部患者在1~5 年得血管累积通畅率分别是93%、87%、85%、77% 以及72%.结论 原位大隐静脉旁路术治疗下肢动脉硬化闭塞效果比较好,同时采用重建手术更能够保证移植血管的畅通,值得推广.     

腋-股动脉旁路转流术治疗主髂动脉硬化闭塞症

目的探讨腋-股动脉人造血管转流治疗主髂动脉硬化闭塞症的疗效。方法24例主髂动脉硬化闭塞症患者（30条患肢）,采用腋（同侧）-单股动脉或者腋双股动脉人造血管转流术治疗。结果1例术后并发败血症而截肢,23例手术成功,缺血症状缓解,有效率达96．7％;随访1年,通畅率达73.3％;7例（8条）人造血管闭塞的患者,5例（6条）经过人造血管取栓手术,血供恢复,2例截肢。结论腋-股动脉人造血管转流术,对于高龄、体弱或其他不适于作解剖旁路转流的主髂动脉硬化闭塞症患者,是一种保存肢体的较安全、有效的治疗方法。     

动脉硬化闭塞症下肢缺血的手术治疗（附28例报告）

目的探讨动脉硬化闭塞症（ASO）下肢缺血的手术效果。方法选择1997~2009年FontaineⅢ、Ⅳ期下肢动脉硬化闭塞症患者28例,采用旁路术、内膜剥脱术及股深动脉成形术重建股深动脉血流。结果21例FontaineⅢ期患者于术后肢体静息痛消失;7例FontaineⅣ期患者术后肢体静息痛消失6例,于术后10 d行截足（趾）术;1例术后静息痛减轻,3个月后彩色多普勒显示人工血管闭塞,行膝下截肢。22例患者得到随访,随访时间3个月~8年。移植血管5年通畅率为86%。结论股深动脉血流重建、旁路术、内膜剥脱术治疗严重肢体缺血具有简单、安全、有效的优点,适合年老体弱不能耐受复杂手术的患者。     

冠状动脉旁路移植术前行左锁骨下动脉狭窄筛查及诊治的临床研究

摘要： 目的 探讨冠状动脉旁路移植术前进行左锁骨下动脉狭窄筛查及诊治的意义和方法。方法 对天津市胸科医院612例冠状动脉旁路移植术患者术前采用无创动脉硬化检测技术筛查合并左锁骨下动脉重度狭窄或闭塞患者， 用电子计算机断层扫描血管造影 （CTA） 明确诊断， 然后行左锁骨下动脉支架成形术， 术后1周行非体外循环冠状动脉旁路移植术， 术中均使用左乳内动脉与前降支吻合。结果 使用无创动脉硬化检测技术筛查出5例左锁骨下动脉狭窄病变患者， 且均得到了CTA确诊。左锁骨下动脉支架成形术成功率为100% （5/5）， 术后残余狭窄率均小于 10%， 症状性患者的症状均消失， 双侧上臂收缩压差均小于20 mmHg。使用左乳内动脉与冠状动脉前降支搭桥术中左乳内动脉血流量正常， 术后心绞痛症状均消失， 未发现冠状动脉-锁骨下动脉窃血综合征。围手术期无脑卒中、 心肌梗死及死亡并发症。随访6~12个月， 平均10个月， 无后循环缺血、 上肢缺血、 心肌缺血相关症状， 双侧上臂收缩压差均小于20 mmHg。结论 无创动脉硬化检测技术对锁骨下动脉狭窄的筛查有独到的价值。     

Usefulness of fasudil, a Rho-kinase inhibitor, to treat intractable severe coronary spasm after coronary artery bypass surgery

We have recently demonstrated that fasudil, a Rho-kinase inhibitor, is effective in suppressing coronary artery spasm in patients with vasospastic angina. Thus, blockade of Rho-kinase may provide a novel therapeutic strategy to treat ischemic coronary syndrome caused by the spasm. Severe coronary artery spasm still remains a life-threatening serious complication of coronary artery bypass grafting (CABG). In this study, we examined the inhibitory effect of fasudil in patients with intractable severe coronary spasm after CABG. Three patients who underwent CABG showed severe myocardial ischemia resistant to intensive therapy with intravenous conventional vasodilators, including isosorbide dinitrate (ISDN), diltiazem, and nicorandil. Coronary angiography revealed severe coronary spasm in native coronary arteries and/or bypass arterial grafts in all patients. Since intracoronary and/or intragraft administration of ISDN was ineffective to resolve the spasm, we then administered fasudil (1.5 mg/min for 15 minutes) into the spastic arteries. Fasudil successfully resolved the spasm and improved myocardial ischemia in all patients without any systemic adverse effects. In conclusion, the treatment with fasudil may be useful to treat intractable and otherwise fatal coronary spasm resistant to intensive conventional vasodilator therapy after CABG.     

不同旁路材料在冠状动脉旁路移植术中的应用

目的总结冠状动脉旁路移植术中目前几种常用旁路材料的临床应用。方法2001-10～2006-10连续106例行冠状动脉旁路移植术,旁路材料包括左乳内动脉(106根)、游离右乳内动脉(42根)、桡动脉(46根)和大隐静脉(86根),回顾分析不同旁路材料的手术结果。结果全组无手术死亡,桡动脉移植后旁路血管“线样征”1例;无胸骨、前臂并发症;下肢切口感染2例,均为糖尿病、大体重患者,治疗后痊愈。结论注意旁路材料的取制技巧,针对不同病变冠脉血管选取应用不同旁路血管,以及术后及时监护处理是保证良好手术结果的关键。     

药物涂层球囊联合血管减容对下肢动脉硬化闭塞病变病人血运重建率、血管内皮功能及踝肱指数的影响

目的观察药物涂层球囊( DCB)联合血管减容对下肢动脉硬化闭塞病变( LEAOD)病人血运重建率、血管内皮功能及踝肱指数( ABI)的影响。方法选择 2018年 6月至 2021年 6月黄河三门峡医院收治的 LEAOD病人 100例,按随机数字表法分两组,对照组( n=50)予 DCB,研究组( n=50)予 DCB联合血管减容。比较靶血管通畅率、靶血管血运重建( TLR)率、再狭窄率、 Rutherford分级情况、血管内皮功能、 ABI、下肢动脉最小管腔直径( MLD)晚期管腔丢失( LLL)值。结果术后 12个月,研究组靶血管通畅率( 92.00%,46/50)均较对照组( 74.00%,37/50)高( P<0.05)。术、后 12个月,研究组 TLR率( 2.00%,1/50)、再狭窄率(0,0/50)均较对照组(18.00%,9/50)、(12.00%,6/50)低( P<0.05)。术后,两组 Rutherford分级情况均优于术前( P<0.05)且研究组 Rutherford分级情况均优于对照组( Z=-2.21,P=0.027)。术后个 12个月,两组血流介导的血管内皮舒张程度值( FMD)、,硝酸甘油介导的血管内皮舒张程度值( NMD)、足背动脉 ABI、胫后动脉 ABI均高于术前( P<0.05)且研究组高于对照组均(P<0.05)。术后个12个月,两组的下肢动脉 MLD、LLL值均低于术后次日( P<0.05)且研究组动脉 MLD高于对照组( P<0.05)下肢,,LLL值低于对照组( P<0.05)。结论 DCB联合血管减容能提高 LEAOD病血管通畅率,降低 TLR率、再狭窄率,改人靶,善 Rutherford分级情况、血管内皮功能、 ABI,调节下肢动脉 MLD、LLL值。     

24例急性下肢动脉缺血性疾病治疗体会

目的 探讨急性下肢动脉缺血性疾病的个体化治疗方法.方法 回顾性分析我院自1998年以来收治的24例急性下肢动脉缺血性疾病患者的临床资料.结果 取栓术及搭桥术组共23例肢体动脉急性缺血症状消失,6例并行截肢(趾)术,远端血管未完全通畅者加行微导管溶栓效果较好.结论 采用个体化方法治疗急性下肢动脉缺血性疾病是安全、可行的有效途径.     

Release of norepinephrine by electrical field stimulation of collateral arteries from the hindlimb of the dog

Studies were conducted comparing the electrical field-stimulated contractile response and endogenous norepinephrine overflow of developing collateral arteries to that of branch arteries from normal extremities. Norepinephrine overflow was measured by radioenzymatic assay. Experiments on collateral arteries were undertaken 6 weeks after occlusion of the femoral artery. Collateral arteries had a lesser contractile response at lower voltages of stimulation with a greater direct smooth muscle component. This occurred despite previously reported greater sensitivity to alpha-adrenergic agonists. Stimulated norepinephrine overflow was significantly greater despite a lower norepinephrine content. These findings may reflect alterations in local control of adrenergic neuronal transmission. The results also suggest an inefficient innervation of vascular smooth muscle by adrenergic nerve endings. Lack of difference between anterior tibial artery from unoccluded (normotensive) and occluded (hypotensive) extremities excluded the possibility that differences between collateral and normotensive branch arteries were due to hypotension alone.     

介入性完全性血运重建对冠状动脉多支病变患者预后的影响

目的：探讨介入性完全性血运重建与非完全性血运重建对多支冠状动脉病变患者预后的影响。方法：回顾性分析接受介入治疗的117例多支冠状动脉病变患者的临床资料及随访情况,根据主要的冠状动脉及其重要分支是否完全再血管化分为完全血运重建组（CR组,45例）和非完全血运重建组（IR组,72例）,比较两组患者围术期死亡率、随访期间心血管总死亡率、急性心脏事件发生率和因心血管原因再次入院率。结果：两组患者的性别构成、原发性高血压、高脂血症、吸烟等相比差异均无统计学意义,非完全血运重建组糖尿病患病率及心肌梗死病史例数较高（分别为44.4%、23.6%,P〈0.05）。与CR组比较,IR组患者冠状动脉重度狭窄（P〈0.05）、3支病变（P〈0.05）及复杂病变（P〈0.01）比例均高,病变数目少而平均置入支架数多（P〈0.05）。随访6～36个月,IR组再发心绞痛（P〈0.01）、再次血运重建比例（P〈0.05）和MACE事件发生率（P〈0.01）均显著高于CR组。结论：与非完全血运重建相比,完全血运重建能显著改善冠心病多支病变患者的预后,对于冠心病多支病变患者,应尽可能达到完全血运重建或功能上的完全血运重建。     

Thrombolytic therapy in peripheral arterial disease

The two main causes of peripheral arterial occlusion (PAO) are embolism and thrombosis. Surgical treatment of acute limb ischemia, because of related complications, has a 30-day mortality rate of 15% to 25%. Intra-arterial thrombolysis for lower extremity ischemia is a well-accepted and frequently used technique. It may offer definitive treatment without the need for major surgery in a significant series of patients with acute occlusion of a native leg artery or a by-pass graft. Thrombolysis can offer several potential advantages when compared with surgical therapy. Thrombolytic agents include streptokinase (SK), urokinase (UK), pro-UK and recombinant tissue plasminogen activators (rt-PA-Alteplase and r-PA-Reteplase). All these agents induce a systemic fibrinolytic state. Three prospective randomized trials, ROCHESTER, STILE, and TOPAS, which compared thrombolytic therapy with traditional surgical revascularization for lower limb ischemia, have recently been published. They suggest that thrombolysis, as an initial therapy, reduces the risk of subsequent surgery and improves limb salvage for patients with PAO. Using this approach, the underlying lesions can be identified and treated by transluminal balloon angioplasty or stenting, or by elective surgical revascularization. However, severe bleeding is still a non rare complication of intra-arterial thrombolysis and the risk of intracranial hemorrhage is 1-2%.     

Antiplatelet therapy in peripheral artery disease

Peripheral artery disease (PAD) is a term that relates to atherosclerosis and narrowing of the arteries in the lower extremities. The prevalence of PAD is approximately 12% of the adult population. Despite the low rate of peripheral complications and amputation, PAD is complicated by a high rate of cardiovascular events including myocardial infarction, stroke, and vascular death with an annual incidence of about 5%.The detection of PAD is initially based on the appearance of typical symptoms (claudication and critical limb ischemia) related to peripheral arterial insufficiency. However, PAD may also be present in the absence of clinical symptoms (asymptomatic PAD). Accordingly, asymptomatic disease may occur in up to 50% of all patients with PAD. Ankle brachial index (ABI) is a diagnostic test used to evaluate the presence of PAD, defined by an ABI ≤0.90. The ABI is also demonstrated to be useful in the assessment of vascular risk in asymptomatic and symptomatic patients. Antiplatelet therapy remains a key intervention to reduce cardiovascular risk in PAD. Data from Antithrombotic Trialists' Collaboration showed that antiplatelet treatment was associated with a 23% risk reduction of vascular events in overall population with PAD. However, closer scrutiny of these data reveals that nonaspirin antiplatelet drugs, including ticlopidine, clopidogrel, picotamide, and dipyridamole largely drove the benefits in the PAD subgroup. It remains an open issue if PAD represents an atherosclerotic clinical model where aspirin, differently from coronary heart disease, is less effective in reducing atherosclerotic progression. Based on the reported results further trials with aspirin should be done in asymptomatic (ABI ≤0.90) and symptomatic PAD patients. Finally, the role of new antiplatelet drugs such as prasugrel and ticagrelor has not yet been studied in PAD.