6例预置管动脉栓塞治疗凶险型前置胎盘合并胎盘植入患者的护理

探讨剖宫产术前股动脉预置管栓塞治疗凶险型前置胎盘合并胎盘部分植入患者的护理.对6例凶险型前置胎盘合并胎盘部分植入的剖宫产患者术前行股动脉置管,待新生儿娩出后,立即行动脉栓塞术.在术前、术中、术后进行护理.6例均栓塞成功,新生儿1分钟、5分钟Apgar评分均10分.股动脉预置管动脉栓塞为治疗凶险型前置胎盘合并胎盘植入的患者提供了一种新的选择,具有迅速、有效、并发症少、出血量少、可保留子宫等优点.     

经股动脉置管溶栓治疗下肢动脉硬化性闭塞症的护理

目的探讨股动脉置管溶栓治疗下肢动脉硬化性闭塞症的护理方法。方法回顾分析2007年12月～2010年3月13例经股动脉置管溶栓治疗下肢动脉硬化性闭塞症的护理。结果经过合理的治疗和护理后本组13例患者恢复良好。结论术前充分准备，术中密切配合，术后严密观察病情，可预防并发症发生，提高手术成功率。     

急性心肌梗死患者主动脉球囊反搏植入术后并发动脉栓塞的预防及护理

目的 探讨急性心肌梗死患者主动脉球囊反搏(IABP)植入术后并发动脉栓塞的预防及护理.方法 对50例应用IABP后发生动脉栓塞的急性心肌梗死患者临床资料进行回顾性分析.结果 植入IABP后发生右下肢动脉栓塞者3例,经过积极治疗及密切护理,2例患者痊愈,1例患者发生下肢坏疽,最终截肢.结论 术前正确的置管、适当的抗凝,术后严密的观察和护理,是预防和及早发现动脉栓塞并发症的关键.     

急性下肢动脉栓塞取栓术16例围术期护理干预

目的:探讨急性下肢动脉栓塞患者围术期的护理干预方法及效果。方法:回顾性分析16例急性下肢动脉栓塞患者的临床资料,总结围术期护理干预经验。结果:14例术后栓塞动脉完全开通,2例部分开通;13例临床症状完全缓解,3例部分缓解;1例术中发生脑梗,1例留有跛行,1例并发肺部感染的患者经抗感染雾化排痰等措施后治愈。结论:围术期精心护理干预对辅助患者肢体功能恢复,缩短住院时间,减轻患者心理负担,促进患者早日康复等具有重要意义。     

应用溶栓导管治疗急性下肢动脉血栓形成的效果观察与护理

目的 探讨应用溶栓导管溶栓治疗急性下肢动脉血栓形成的效果及护理方法.方法 对26例急性下肢动脉血栓患者介入下股动脉穿刺血栓内置入溶栓导管,通过术中脉冲推注尿激酶及协同术后经溶栓导管微量泵持续泵入尿激酶溶栓,术后加强溶栓导管的护理及患肢血运的观察.结果 11例术中完全开通,9例48 h内复通,6例部分溶通,但血栓平面均有所下降,症状明显改善.结论 介入置入溶栓导管治疗急性下肢动脉血栓是有效的.     

Fogarty管取栓术及抗凝溶栓联合治疗急性下肢动脉栓塞的效果观察

目的探讨Fogarty管取栓术联合术中、术后抗凝溶栓治疗急性下肢动脉栓塞的临床疗效。方法采用股动脉切开Fogarty取栓管自远心端取栓及术中、术后给予抗凝治疗急性下肢动脉栓塞患者95例,观察治疗效果。结果所有患者术中均有进心端喷血远心端回血,术后3例出现反复血栓形成,2例截肢,3例侧支循环建立,1例患者出现下肢深静脉血栓,随即出现肺动脉栓塞死亡。急性动脉栓塞救肢率达94.7%。经3个月～4年随访(67例,随访率70.5%),发现术前症状、体征均消失。结论 Fogarty取栓管治疗急性下肢动脉栓塞可在局麻下完成手术,远离病变血管,可选取相对表浅的部位切开,简化手术操作,提高手术的安全性,减少术中出血量,缩短手术时间,减少手术损伤和并发症,具有很强的临床应用价值。Fogarty取栓管可在术中取出大部分血栓,但细小动脉内血栓无法完全取出,故术中及术后予以抗凝溶栓治疗是手术取得成功的关键因素之一。     

Angiojet血栓抽吸系统联合置管溶栓在急性肢体动脉栓塞疾病中的应用

目的观察并总结Angiojet血栓抽吸系统联合置管溶栓在急性肢体动脉栓塞疾病治疗中的临床疗效及经验。 方法回顾性分析安徽医科大学附属合肥医院介入血管疼痛科2015年3月至2016年5月应用Angiojet血栓抽吸系统联合置管溶栓治疗18例急性肢体动脉栓塞疾病患者的临床资料。描述其临床治疗效果及并发症发生情况。 结果所有18例患者均使用了Angiojet血栓抽吸系统来处理血管闭塞段,治疗后闭塞段均得到了有效开通,其开通率为100%,术中术后均未出现出血、穿孔等严重并发症。 结论Angiojet血栓抽吸系统联合置管溶栓在治疗急性肢体动脉栓塞疾病方面具有疗效显著、创伤小、安全性高等优点,可以作为急性肢体动脉栓塞患者的一种治疗选择。     

急性下肢缺血的治疗策略（附88例报告）

目的：探讨急性下肢缺血的治疗方法。方法：回顾分析2007年1月-2008年6月因急性下肢缺血行手术治疗的88例患者的临床资料。结果：59例术前诊断急性动脉栓塞的患者急诊行单纯Fogarty导管取栓术,50例术中证实为栓塞,取栓后预后良好（总有效率94．0％）;另有9例术中考虑动脉狭窄伴急性血栓形成,围手术期截肢率高达67．7％。29例术前诊断下肢动脉狭窄伴急性血栓形成的患者,经溶栓或PTA治疗后,有效率89．7％。结论：单纯动脉取栓仅适用于急性动脉栓塞的患者,治疗下肢动脉狭窄伴急性血栓形成需联合溶栓或PTA治疗。     

选择性肾动脉置管溶栓治疗肾动脉栓塞的护理体会

目的:总结选择性肾动脉置管溶栓治疗肾动脉栓塞的护理经验。方法:对5例肾动脉栓塞行肾动脉置管溶栓治疗患者,术前进行心理护理,术后进行生命体征监测、导管护理及并发症的观察与护理。结果:5例肾动脉栓塞行肾动脉置管溶栓后,3例栓塞完全溶解,2例栓塞部分溶解,腰痛症状明显减轻。结论:置管溶栓后,通过护士精心护理,可提高溶栓效果,减少并发症的发生。     

子宫动脉栓塞术治疗子宫肌瘤的临床观察与护理

目的：探讨子宫动脉栓塞术治疗子宫肌瘤的手术前后的观察和护理体会。方法：总结36例行双侧子宫动脉栓塞术的子宫肌瘤患者术前心理及常规护理,术后出现的腹痛、腹胀、阴道出血以及可能出现的并发症的预防和护理。结果：36例患者均顺利行双侧子宫动脉栓塞术,无患者出现术后感染,穿刺点出血,下肢动、静脉血栓形成等并发症。结论：子宫动脉栓塞术治疗子宫肌瘤安全、有效,术前心理护理、充分准备,术后常规护理及可能出现的并发症的预防和护理是护理工作的重点。     

Screening for extermity arterial injury with the arterial pressure index

Certain extremity injuries presenting to the ED or Trauma Unit warrant increased suspicion for underlying arterial trauma. Such injuries include knee dislocations, displaced medial tibial plateau fractures and other displaced bicondylar fractures around the knee, open or segmental distal femoral shaft fractures, floating joints, gunshot wounds in proximity to neurovascular structures, or mangled extremities. Once the diagnosis of arterial trauma is made, a multi-disciplinary approach is warranted. The diagnostic strategies for vascular injury have undergone an evolution over the past 2 decades. One and a half percent to 4.6% of patients hospitalized with blunt extremity trauma have associated vascular compromise [Bunt TJ, Malone JM, Moody M, et al. Am J Surg 1990;160(2):226-8; Reid JD, Weigelt JA, Thal ER, et al. Arch Surg 1988;123(8):942-6; Applebaum R, Yellin AE, Weaver FA, et al. Am J Surg 1990;160(2):221-4; discussion 224-5; Dennis JW, Frykberg ER, Veldenz HC, et al. J Trauma 1998;44(2):243-52; discussion 242-3]. An efficient and effective evidence-based approach to diagnosing vascular injury is necessary, as the difficulty in diagnosis, the multiplicity of diagnostic strategies, the limited time frame in which to initiate appropriate treatment, the limb threatening complications of a missed diagnosis, and the increased awareness of health care expenditures make this entity an intimidating diagnostic challenge [Johansen K, Lynch K, Paun M, et al. J Trauma 1991;31(4):515-9; discussion 519-22; Lynch K, Johansen K. Ann Surg 1991;214(6):737-41; Walker ML, Poindexter Jr JM, Stovall I. Surg Gynecol Obstet 1990;170(2):97-105; Kendall RW, Taylor DC, Salvian AJ, et al. J Trauma 1993;35(6):875-8]. The purpose of this article is to present an evidence-based algorithm for patients who present with either arterial injury or a high-risk of arterial injury. A diagnostic algorithm will be presented, and the rationale for diagnostic interventions will be discussed in the context of current medical literature.     

Composite arterial grafting

The success of coronary artery bypass grafting, the gold standard for the treatment of multivessel coronary artery disease, is limited by poor long-term vein-graft patency. By contrast, the left internal mammary artery has been demonstrated to have a superior graft patency rate and has provided excellent clinical results. This suggests that the use of arterial conduits for coronary artery bypass grafting may be beneficial for long-term results. Recently, there has been an upsurge in the use of arterial grafts for myocardial revascularization based on the clinical advantage of the use of the left internal mammary artery as a bypass conduit. Many retrospective studies have supported the safety and the effectiveness of arterial grafting, and it has become apparent that the free arterial graft can be used as a branched or a lengthened conduit to the in situ arterial graft by adopting one or more of the several composite grafting techniques. Arterial composite grafts with or without sequential grafting techniques appear an attractive strategy as increased number of distal coronary anastomoses can be performed, with a limited number of grafts, avoiding proximal aortic anastomoses. However, concerns regarding the total dependence of the coronary bypass flow on the flow of one in situ arterial graft and technical error, resulting in compromised flow in one or both limbs of the composite graft have prevented composite arterial grafting from being universally adopted. It is expected that in the near future a prospective, multi-institutional, randomized controlled trial, to compare the short- and long-term outcomes of exclusive arterial grafting using composite and conventional aortocoronary revascularization strategies, will be undertaken to validate the safety and efficacy of composite arterial grafting.     

Peripheral arterial disease

AMA Category 1 credit (2 hr), AAFP Prescribed credit (1 hr), and AOA Category 2B credit (1 hr) may be obtained by reading the article beginning on page 158 and submitting the related quiz. The other articles in this group are followed by self- assessment questions.     

Pulmonary arterial hypertension

Pulmonary arterial hypertension (PAH) is a rare and debilitating disease characterized by abnormal proliferation and contraction of pulmonary vascular smooth muscle cells. The resulting increase in pressure and pulmonary vascular resistance results in progressive right heart failure, low cardiac output, and ultimately death if left untreated. PAH is defined by a persistent elevation in pulmonary artery pressure with normal left-sided pressures, differentiating it from left-sided heart disease. Symptoms progress from shortness of breath and decreasing exercise tolerance to right heart failure, with peripheral edema and marked functional limitation. Exercise-induced syncope, worsening symptoms at rest, and intractable right heart failure indicate critical disease. PAH may be idiopathic with no identifiable cause or associated with collagen vascular diseases, drugs, HIV, liver disease, and/or congenital heart disease. Familial or genetically mediated PAH accounts for a small percentage of cases. Advances in the understanding of pathobiological pathways that contribute to vascular proliferation and remodeling have resulted in new therapies that improve quality of life and survival. Emerging therapies focus on the nitric oxide, prostacyclin, and endothelin pathways. Nursing interventions are critical to ensure patients' success with these expensive and complex treatments and their optimal adjustment to living with PAH.     

Cerebral arterial fenestration

Fenestration or duplication of a cerebral vessel is a rare congenital variation which most commonly involves the vertebral artery and is usually of no clinical significance. Fenestrations may have associated aneurysms remote to the anomaly or involving the proximal bifurcation of the fenestration. They may also be associated with other vascular malformations e.g. arteriovenous malformations and venous angiomas. Four fenestrated cerebral vessels and their angiographic appearances are reported in this study.     

Assessment of arterial disease and arterial reconstructions by intravascular ultrasound

Clinical application of intravascular ultrasound to assess arterial atherosclerotic disease was introduced in humans after extensivein vitro andin vivo animal studies. Real-time images, obtained with a 30 MHz element mounted on a 5 F catheter, consistently confirmed angiographic images, up till now considered to be the gold standard. In addition to these data, ultrasonic cross-sectional imaging provided information on the composition of atheroselectic lesions and the size and shape of the lumen. Based on the experimentally derived criteria for tissue characterization, a better insight into arterial morphology could be obtained, allowing improved planning of interventional or reconstructional procedures. Moreover intravascular ultrasound has proved valuable as a post-interventional procedure to monitor and assess the quality of interventional results. The ultrasound images are clearly superior to angiographic studies, albeit the ultrasonic information is an adjunct to angiography and, as yet, not a substitute. We present our initial experience with intravascular ultrasound obtained in patients with substantial peripheral arterial disease.