内膜下再通术治疗外周动脉完全闭塞性病变

目的探讨内膜下再通技术（SIR）治疗外周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18例患者的20处外周动脉完全闭塞病变。闭塞病变分别位于下肢动脉（髂股动脉14处、膝以下动脉4处）和左锁骨下动脉（2处）。内膜下再通的基本操作步骤：血管造影后导管抵近闭塞动脉近端，使用直径0．035in（1in=2．54cm）的TERUMO超滑导丝，穿通动脉内膜后在闭塞段动脉内膜下腔中前行，通过闭塞段后重入动脉真腔。建立闭塞段动脉内膜下通道后使用球囊扩张成形。除膝以下动脉和1处髂动脉之外，均在开通的内膜下通道起始部或全程置放自膨式支架。结果15例患者的17处病变内膜下再通治疗获得成功，临床症状显著改善。无动脉穿孔、血栓形成或动脉粥样硬化斑块脱落栓塞等并发症。3例技术失败患者临床症状无变化，失败原因分别是导丝不能重入内膜真腔和内膜下腔，扩张成形不满意。结论内膜下再通技术治疗外周动脉闭塞病变可行性强、疗效显著、安全性良好、技术相对简便；在治疗比较复杂的动脉闭塞病变时是传统经皮血管腔内成形术（PTA）的重要补充手段。     

双向内膜下血管成形术在治疗下肢动脉闭塞症中的应用

目的 探讨双向内膜下血管成形术在治疗周围动脉完全闭塞性病变中的意义。方法 采用双向内膜下血管成形术治疗5例长段动脉闭塞患者,其中腹主动脉下端合并两侧髂总动脉及髂外动脉闭塞1例,髂外动脉闭塞2例,股浅动脉闭塞2例。在单向内膜下再通时,进入真腔失败后而在患肢闭塞动脉远端血管穿刺,使用导丝从病变对侧进入闭塞段内膜下,在病变内膜下腔,采用导丝贯穿至对侧导管技术,成功后,将导丝从对侧导管引出体外,然后用球囊扩张成型并植入支架。结果 本组5例患者均成功完成双向内膜下再通,共植入支架9枚。结论 双向内膜下再通可以作为单向内膜下再通进入真腔失败时的补救方法,可有效提高血管成形术的成功率。     

逆行突破技术在股-腘动脉闭塞症腔内治疗中的应用

目的探讨股-腘动脉闭塞症患者腔内介入治疗逆行穿刺的再通成功率及临床应用价值。方法回顾性分析16例股-腘动脉闭塞症患者的临床资料。当顺行开通失败后,在DSA和/或超声引导下逆行穿刺病变远端动脉,逆行或双向突破完成腔内再通治疗,评价逆行穿刺技术的再开通成功率,并观察手术并发症情况。结果本组16例患者逆穿技术成功率及再通治疗成功率均为100%。患者术前平均踝臂指数(ankle brachial index,ABI)0.329±0.109,术后5~7天平均ABI值0.693±0.122,有显著统计学差异(t=12.381,P0.01);腘动脉穿刺点出血1例,并发症发生率6.25%(1/16)。结论股-腘动脉闭塞症逆行开通成功率高,并发症少,可作为股腘动脉顺行再通失败患者的首选补救术式,能有效提高腔内治疗成功率。     

慢性主-髂动脉闭塞内膜下再通治疗的可行性及初步应用

目的 探讨经动脉内膜下途径治疗主.髂动脉闭塞的可行性与治疗方法.方法 对1例慢性主髂动脉闭塞患者经右肱动脉穿刺,使用超滑导丝自腹主动脉闭塞端穿入内膜下腔,分别向两侧髂动脉行内膜下再通.右侧导丝顺利重入髂外动脉真腔,左侧使用了双向内膜下再通技术.2支导丝经双侧股动脉穿刺点引出体外.经两侧股动脉用对吻技术行球囊扩张和支架置放(主动脉下端支架1枚,双侧髂动脉支架5枚).结果主-髂动脉闭塞经内膜下途径成功再通.治疗后主.髂动脉支架内腔形态良好,血流通畅.双下肢缺血症状完全消失,踝臂指数(ABI)由0.32上升至0.96.10个月随访未见再狭窄表现.结论 经动脉内膜下途径治疗主.髂动脉闭塞安全、可行,适用于慢性动脉硬化闭塞病变.     

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。     

导丝成袢技术在慢性长段股腘动脉闭塞病变开通中的应用

目的 探讨导丝成袢技术治疗慢性长段股腘动脉完全闭塞病变的技术要点和疗效.方法把导丝头端塑成一个U型袢,顺势用该袢开通闭塞血管病变,并逐步跟进导管,使导丝进人流出道真腔内.结果 52例股腘动脉长段(≥10 cm)闭塞患者中48例采用该技术成功地开通闭塞的股腘动脉,技术成功率92.3%;3例开通失败,1例无法开通.结论导丝成袢技术治疗长段股腘动脉闭塞病变可行性强、疗效显著、安全性良好、技术相对简便.     

介入治疗复杂下肢动脉硬化闭塞症技术与疗效分析

目的 探讨根据下肢动脉硬化闭塞症( ASO)复杂病变的影像特征进行个体化介入治疗的方法和效果.方法 回顾性分析78例下肢动脉ASO复杂病变患者的临床、影像和随访资料.68例为泛大西洋学会共识(TASC)ⅡC或D级病变,10例为影像特征较复杂的TASCⅡB级病变;共103处病变.临床表现Fontaine stageⅢ、Ⅳ型和较重的Ⅱ型.在具有较好的流出道血管及适用的穿刺入路基本条件下,将长段闭塞、平齐闭塞、多发闭塞、腘动脉闭塞、膝以下动脉闭塞以及主髂动脉闭塞等复杂病变均视为适应证,针对病变影像特点灵活选择穿刺入路,应用内膜下再通技术顺行开通或双向开通闭塞段.对术后踝臂指数(ABI)行t检验.结果 73例患者再通治疗获技术成功,未发生重要并发症.再通后肢体缺血症状立即减轻,平均ABI由术前0.45±0.07增加至0.76±0.11(t=- 19.78,P＜ 0.01).5例再通失败者未导致症状恶化.47例随访6～12个月,22例未见肢体缺血症状复发.结论 根据影像特征指导选择介入治疗方法能避免TASC分型指导适应证选择的局限性,使更多ASO病变通过非手术方法得到有效治疗.     

慢性长段股腘动脉闭塞病变介入治疗分析

目的评价慢性长段股腘动脉完全闭塞病变腔内介入治疗技术及其临床意义。方法回顾总结56例慢性长段股腘动脉完全闭塞性病变,多种介入治疗技术如血管再通术、导管溶栓术、PTA及内支架置入术等的综合应用治疗效果。结果技术成功率92.9%(52/56)。52例开通者治疗后肢体状态改变为:+3:14例;+2:29例;+1:9例。踝/肱指数(ABI)由术前平均0.46±0.12增至术后平均0.83±0.08。随访48例,+3:11例;+2:24例;+1:6例;0:4例;-1:1例;-2:2例。症状改善总有效率为85.4%(41/48)。结论多种介入技术治疗股腘动脉完全闭塞病变安全、有效。     

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...     

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...     

Strategies for Successful Percutaneous Revascularization of Chronic Total Occlusion of the Femoropopliteal Arteries When the Antegrade Passage of a Guide Wire Fails

Objective

To evaluate the efficacy of various strategies for revascularization of chronic total occlusion of femoropopliteal arteries when the guide wire does not pass in an anterograde direction.

Materials and Methods

Twenty-four patients with totally occluded femoropopliteal arteries (mean occlusion length 13.75 cm; range, 6-22 cm) were treated by using a retrograde approach and two novel catheters. After successful recanalization or reentry, balloon angioplasty followed by stent placement was performed to complete the revascularization.

Results

In 16 cases in which to cross the occlusion via intraluminal or subintimal route was failed, we used Frontrunner catheters in five cases and Outback catheters in 11 cases. In eight cases in which to reenter after subintimal passage of the guide wire was failed, we used Outback catheters. Successful recanalization was achieved intraluminally or subintimally in all cases. One perforation occurred during subintimal passage of the guide wire that was controlled by recanalization of another subintimal tract. There were no cases of distal thromboembolism or other complications.

Conclusion

A retrograde approach and using the Frontrunner and Outback catheters are safe and effective for successful revascularization of chronic total occlusion of femoropopliteal arteries. In particular, they are useful when the initial antegrade attempts at recanalization have failed.     

Chronic Total Occlusion of the Iliac Artery: Endoluminal Reentry Using a Metal Stiffening Cannula

When chronic total occlusion of the iliac artery cannot be crossed with traditional guide wires and catheters, the metal stiffener from a universal drainage catheter kit can be shaped and used to direct a guide wire from a subintimal tract into the true lumen. In the present report, reentry was achieved in 12 of 12 patients with the use of the cannula. This technique provides a useful alternative for treatment of chronic total iliac occlusions.     

Subintimal arterial flossing with antegrade-retrograde intervention (SAFARI) for subintimal recanalization to treat chronic critical limb ischemia

PURPOSE: To describe the technique of subintimal arterial flossing with antegrade-retrograde intervention (SAFARI) to improve technical success for the performance of subintimal recanalization when there is failure to reenter the distal true lumen or when there is a limited segment of patent distal target artery available for reentry. MATERIALS AND METHODS: Subintimal recanalization was attempted in an antegrade direction in all patients. If reentry into the distal true lumen was unsuccessful or a short segment of target artery was present, retrograde access was obtained in the distal target artery (popliteal, anterior tibial/dorsalis pedis, or posterior tibial) and a retrograde subintimal channel was created. A guide wire was used to connect the retrograde and antegrade subintimal channels simultaneously to create a "flossing" guide wire. The subintimal tract was dilated with balloon angioplasty with or without stent implantation. Limb salvage, amputation-free survival, and survival rates over time were determined. RESULTS: The SAFARI technique resulted in successful subintimal recanalization creating straight-line flow to the foot in all 21 limbs in 20 patients in which the technique was attempted. Antegrade-retrograde access was performed with the femoral artery and the following vessels: popliteal, n = 11; anterior tibial/dorsalis pedis, n = 10; and posterior tibial, n = 2 (two limbs involved multiple accesses). All procedures were successful. The limb salvage rate with SAFARI was 90% (95% CI, 74%-100%) at 6 months. CONCLUSIONS: The SAFARI technique can be useful for completing subintimal recanalization when there is failure to reenter the distal true lumen from an antegrade approach or when there is limited distal target artery available for reentry. The SAFARI technique improves technical success in the performance of subintimal recanalization. Limb salvage rates are comparable to those with antegrade subintimal recanalization.     

Transcollateral approach for percutaneous revascularization of complex superficial femoral artery and tibioperoneal trunk occlusions

This report describes the use of transcollateral retrograde revascularization in two patients after failed recanalization of the tibioperoneal trunk in one and superficial femoral artery occlusion in the other. Retrograde recanalization was successfully achieved via a distal branch of the profunda femoris artery in the first case and a medial genicular branch in the second. After successful retrograde recanalization, the guide wire was snared in both cases and angioplasty/stent placement was performed in an antegrade fashion.     

Bilateral transpopliteal approach for treatment of complex SFA and iliac occlusions

We present a successful case of percutaneous intentional extraluminal recanalization (PIER) of bilateral long superficial femoral artery (SFA) occlusions and a long iliac artery occlusion through ultrasound-guided retrograde popliteal artery punctures. To our knowledge, PIER of SFA occlusions via popliteal approach has been reported in only three cases, and subintimal recanalization of combined SFA and iliac occlusions has not been reported.     

Subintimal Recanalization of Peripheral Chronic Occlusive Arterial Disease with Modified Transseptal Needle

PurposeTo report an alternative technique of subintimal recanalization of chronically occluded lower-extremity arteries using a modified transseptal needle (MTSN) to reenter the true lumen.Materials and MethodsFrom December 2008 to December 2010, 98 patients with chronic arterial occlusions were treated with endovascular techniques. True lumen reentry with conventional subintimal techniques failed in 23 of these patients (24%). Retrospective review of medical records and procedure data was performed, and clinical presentation, lesion location, Trans-Atlantic Inter-Society Consensus II classification, amount of calcification, procedure time, recanalization time with conventional subintimal technique, recanalization time with the MTSN, and complications were recorded. During the 24-month period, 11 common iliac arteries (CIAs), three external iliac arteries (EIAs), one combined CIA/EIA, six superficial femoral arteries (SFAs), and two combined SFA/popliteal arteries were treated with MTSNs.ResultsSuccessful recanalization with the MTSN was obtained in 21 patients (91%). There was one complication of pseudoaneurysm formation in the EIA. The average occlusion length of the CIA was 6.7 cm; that of the SFA was 15.9 cm. The average procedure time was 73 minutes, with 20 minutes used to attempt to reenter the true lumen and 6.3 minutes used to reenter the true lumen with the MTSN.ConclusionsThe MTSN technique is safe and effective and offers another approach to reenter the true lumen of chronic total arterial occlusions during subintimal recanalization in difficult cases.     

Case of effective suction to secure the true lumen for acute occlusion after carotid endarterectomy

During or following carotid endarterectomy, dissection and occlusion of the internal carotid artery can occur. In cases of stenosis or almost complete occlusion, recanalization is relatively easy; however, in cases of complete occlusion, advancing a guidewire into the true lumen may be challenging. Few reports on how to address this problem have been published. Here, we report a case of suction-enabled advancement of the wire into the true lumen during endovascular treatment of an acute occlusion of the internal carotid artery after carotid endarterectomy. An 80-year-old man underwent carotid endarterectomy; the next morning, he exhibited aphasia and right-sided paralysis, and magnetic resonance images showed left cerebral infarction and left internal carotid artery occlusion. The patient was transferred to our hospital for recanalization. Imaging with contrast material showed that the left internal carotid artery was completely occluded. During recanalization, futile attempts were made to advance the wire into the true lumen. The occlusion was aspirated, and angiography then showed an inflow of contrast material into the vessel, which indicated slight distal widening; this widening allowed the wire to move into the true lumen. The occlusion extended distally, and 2 stents were placed over the entire lesion. Good recanalization was eventually achieved.