Deep球囊PTA治疗膝下动脉闭塞性疾病

对40例（47条肢体）膝下动脉闭塞症患者采用Deep球囊经皮血管腔内成形术（PTA）进行治疗。手术成功44条肢体。术后静息痛消失30条肢体（68.2%）,明显缓解15条肢体（34.1%）;足部溃疡愈合6条肢体,膝下截肢1条肢体,半足切除3条肢体;术后踝/肱指数（ABI）为0.73±0.21,较术前的（0.22±0.19）有显著提高（P〈0.01）。认为采用Deep球囊PTA治疗膝下动脉闭塞性疾病疗效好,可明显降低截肢率,具有创伤小、可重复性等优点。     

膝下动脉闭塞性病变40例腔内治疗的疗效分析

目的 探讨经皮腔内血管成形术（PTA）对膝下动脉闭塞性病变（包括血栓闭塞性脉管炎、下肢动脉硬化闭塞症、糖尿病足）的治疗效果。方法 回顾性分析山东省潍坊市人民医院2008年3月至2014年7月40例（40条患肢）膝下动脉闭塞性病变的临床资料,采用PTA对狭窄或闭塞性病变进行球囊扩张。结果 39条肢体获得影像学成功（残余狭窄率＜20%）,技术成功率及初次开通率为97.5%（39/40）。肢体保全率为95%（38/40）,保肢率为97.5%（39/40）。并发症有动脉穿孔（2例）、穿刺点血肿（1例）、急性心肌梗死（1例）。39例术后肢体间歇性跛行、疼痛、溃疡等临床症状均改善,踝肱指数(ABI)由术前的（0.32±0.27）增至术后10d的（0.86±0.19）,差异具有统计学意义（P＜0.01）。术后12个月ABI值为（0.80±0.20）,术后12个月肢体保全率为95%（38/40）。结论 PTA治疗膝下动脉闭塞性病变是一种安全有效的治疗方法。     

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。     

下肢动脉硬化性闭塞症多节段复杂病变的杂交手术治疗

目的:探讨下肢动脉硬化闭塞症(ASO)多节段复杂病变的治疗手段及临床疗效。方法:采用杂交手术治疗ASO多节段复杂病变,患者21例,切开股总动脉行髂动脉Fogarty导管取栓术+髂动脉血管腔内成形术(PTA)+支架(STENT)2例,髂动脉PTA+STENT+股总动脉内膜切除术(TEA)4例,髂动脉PTA+STENT+股总动脉TEA+股动脉Fogarty导管取栓术1例,髂动脉PTA+STENT+股总动脉TEA+股腘动脉人造血管旁路移植术1例,髂动脉PTA+STENT+股总动脉TEA+股浅动脉PTA+STENT2例,髂动脉PTA+STENT+股总动脉TEA+膝下动脉PTA2例,髂动脉PTA+STENT+股总动脉TEA+股深动脉扩大成形术2例,股总股浅动脉TEA+股浅动脉PTA+STENT3例,股浅动脉TEA+腘动脉PTA+膝下动脉PTA3例,先行膝下动脉远端流出道的PTA治疗,而后同期进行股腘动脉人造血管移植术1例。结果:手术成功率为100%,未出现严重并发症,踝肱指数(ABI)复查由0.31升至0.66(正常值0.53～0.91)。分别于术后3,6,9个月及12个月进行Ⅰ期临床评估及彩色多普勒超声检查,1例11个月死于急性心肌梗死,2例再狭窄,1年通畅率90%(18/20)。结论:杂交手术治疗多节段复杂病变的下肢动脉硬化闭塞症患者安全、创伤小及通畅率高。     

老年TASCⅡC、D型LEAOD完全闭塞病变腔内治疗的疗效

目的探讨血管腔内治疗老年主-髂动脉闭塞(TASC)ⅡC、D型下肢动脉硬化闭塞症(LEAOD)完全闭塞病变的可行性及近期临床疗效。方法回顾性分析采用腔内治疗的27条患肢(21例患者)老年下肢TASCⅡC、D型LEAOD的临床资料。结果手术成功率为88.9%(24/27),其中经皮腔内血管成形术(PTA)治疗3条,PTA联合支架植入术(PTAS)治疗21条,共置入支架57枚。手术成功病例平均随访8.75个月(6¹8个月),术后3个月足背动脉踝肱指数(ABI)由术前的0.39±0.14上升至0.8±0.19(P<0.01);胫后动脉ABI由术前的0.45±0.12上升至0.90±0.10(P<0.01)。术后6个月动脉通畅率83.3%(20/24),保肢率95.8%(23/24)。结论对于老年TASCⅡC、D型LEAOD完全闭塞病变,血管腔内治疗安全有效,创伤小,近期临床疗效满意。     

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。     

经腘动脉入路逆行内膜下血管成形术治疗股浅动脉长段硬化性闭塞症

目的探讨经腘动脉入路逆行内膜下血管成形术治疗股浅动脉长段硬化性闭塞症的可行性和近期效果。方法回顾性分析17例因股浅动脉/腘动脉近端完全闭塞接受经腘动脉入路逆行内膜下血管成形术/支架置入术患者的资料,总结技术成功率和近期临床疗效,分析术中术后并发症发生情况及防治方法。结果腘动脉穿刺成功率和手术即时成功率为100%。踝臂指数(ABI)从术前的0.43±0.23上升至0.89±0.26(P<0.01)(出院前),6个月(0.86±0.25)及12个月(0.81±0.23)(P<0.01)时保持改善状态。术后6个月的初次通畅率为94.7%(16/17);12个月时初次通畅率为76.5%(13/17),再次通畅率为100%。并发症(3例,17.6%)主要有腘动脉穿刺点假性动脉瘤、股动脉穿刺点出血及肢体远端动脉急性栓塞,根据情况给予了相应处理。结论对于长段股浅动脉/腘动脉近端闭塞性病变,在腔内顺行开通失败的情况下运用经腘动脉入路逆行内膜下血管成形术/支架置入术是一种安全有效的补救措施。     

经皮腔血管成形术联合血管内支架治疗下肢动脉硬化闭塞症的临床疗效研究

目的探讨经皮腔血管成形术(PTA)联合血管内支架治疗下肢动脉硬化闭塞症的临床疗效。方法选取2010年12月—2015年10月武汉市第一医院收治的下肢动脉硬化闭塞症患者32例。均在DSA室的X线引导下行PTA;对于近两年内有髂动脉严重狭窄的患者,行PTA后置入血管内支架。记录患者的临床疗效。结果 PTA的即时成功率为90.6%(29/32),手术成功的29条患肢中3条踝肱指数(ABI)无明显改善,余26条由术前的(0.42±0.11)恢复至(0.82±0.12)。随访3~45个月,1例患者的胫后动脉在术后第9个月发生再次闭塞,2例患者的腘动脉在术后第12个月发生再次闭塞,手术通畅率为88.5%(23/26)。结论 PTA联合血管内支架治疗下肢动脉硬化闭塞症的临床疗效确切,可有效提高患者病变血管通畅率,值得在临床上推广应用。     

长微球囊导管在糖尿病性小腿动脉硬化治疗中的应用

目的 初步探讨长微球囊导管在经皮腔内血管成形(PTA)治疗糖尿病性小腿动脉硬化中的临床应用.方法 糖尿病性小腿动脉硬化39例,其中男28例,女11例,共56条患肢.术前CTA(23例),MRA(16例).26条患肢小腿3条动脉(胫前、胫后和腓动脉)完全闭塞,19条患肢1条血管狭窄2条闭塞,5条患肢1条血管正常(腓动脉)2条闭塞,6条患肢2条血管狭窄1条闭塞.利用在治疗过程中对血管损伤小的长微球囊导管对小腿3条动脉狭窄或闭塞进行PTA治疗.球囊的长度选择80～120 mm,直径选择与病变血管相同或小于0.5 mm,扩张时间为3～5 min.术后进行血管造影复查,如有狭窄再次进行球囊扩张.结果 56条患肢完成PTA的有52条(92.9%).47条(83.9%)患肢远近血管的再通达到足部,踝肱指数(ABI)术前、术后分别为0.37±0.15和0.88±0.16,9条(26.5%)患肢再次出现缺血症状,其中5条患肢病变血管再狭窄,4条患肢病变血管闭塞,再次成功进行血管成形治疗.结论 利用长微球囊导管进行PTA是治疗糖尿病性小腿动脉硬化的一种安全、有效的微创方法.     

血管镜辅助下内膜切除术治疗长段股—腘动脉闭塞35例疗效观察

目的提高长段股—腘动脉闭塞性病变的治疗水平。方法对35例长段股—腘动脉闭塞性病变患者行血管镜辅助下半闭合式内膜切除术：依据术前影像学资料,在病变动脉远、近端纵形切开,切除动脉内膜。动脉腔内引入血管镜,检查残留斑块或内膜,用Fogarty取栓导管或内膜剥脱器进一步处理,缝合固定远端内膜断端。结果手术成功率100%,动脉内膜切除长度10～36（25±8）cm,手术时间85～250（160±70）min。其中5例同时行股深动脉扩大成形术,3例行髂动脉球囊扩张及支架植入术,1例行髂外动脉内膜切除术。术后出现切口并发症2例,足趾溃疡5例,均经换药后愈合。术后踝肱指数由术前0.45±0.13提高至0.95±0.18（P〈0.01）。术后2周经动脉置管造影证实股—腘动脉通畅率100%。随访1～24个月,累积通畅率85.7%,保肢率100%。结论血管镜辅助下半闭合式内膜切除术治疗长段股—腘动脉闭塞性病变安全有效,近期通畅率与旁路手术及腔内介入手术相近,远期通畅率有待进一步观察。     

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.     

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。     

重组人凝血因子Ⅶa用于高危心脏手术后严重出血治疗的回顾性分析

目的:总结重组人凝血因子Ⅶa(rFⅦa)治疗高危心脏手术后严重出血的治疗经验。方法:对2006年10月至2007年6月13例高危心脏手术后严重出血的患者应用rFⅦa治疗后进行回顾性分析。其中男性9例,女性4例,年龄5～60岁,平均38岁。手术包括主动脉手术6例,瓣膜置换术5例,心脏移植1例,复杂先天性心脏病(先心病)1例,监测应用rFⅦa前后的治疗效果及不良反应。结果:应用rFⅦa后,心包及纵隔引流量明显减少〔(1136±348)mL对比(318±114)mL,P0.005〕;凝血酶原时间(PT)明显缩短〔(16.8±5.9)s对比(11.3±3.3)s,P0.05〕;国际标准化比值(INR)明显减小〔(1.3±0.4)对比(0.9±0.3),P0.05〕;活化部分凝血活酶时间(APTT)则在用药前后差异无统计学意义〔(53.2±8.8)s对比(45.6±8.2)s,P=0.355〕。术后死亡1例(死亡原因为多器官功能衰竭),远期发生脑梗死1例。未发现心肌梗死及其他血栓性并发症。结论:对于高危心脏手术后的严重大出血的患者,及时应用rFⅦa可获得满意的治疗效果,可减少引流量,降低血液制品的输注,且不良反应发生率低。     

厄贝沙坦对冠心病患者非心脏手术围术期的影响

目的:探讨血管紧张素Ⅱ受体拮抗剂(AngiotensinⅡ receptor blocker ARB)类降压药厄贝沙坦应用对有心肌缺血病变患者的围术期保护作用的临床疗效。方法:60例行非心脏手术(noncardiac surgery)的冠心病(coronary artery disease CAD)患者,美国麻醉师协会分级(American society of anesthesiologists classification,ASA classification)Ⅱ-Ⅲ级,随机分为厄贝沙坦(A组)、对照组(B组),每组各30例。分别测定患者麻醉前(T0)、术后3d(T1),术后10d(T2)的心肌肌钙蛋白I(cTnI)的浓度,并统计心电学变化状况、心脏事件发生率。结果:在T1、T2时点,所有组别cTnI浓度与T0相比较均升高(P0.05),T1时点的A组(0.157±0.120)μg/L及B组(0.161±0.142)μg/L患者血cTnI浓度在2组间差异无统计学意义(P0.05),T2时点的cTnI浓度及阳性率B组(0.268±0.225)μg/L高于A组〔(0.098±0.089)μg/L,P0.05〕差异有统计学意义。术后短期内A组10例(33.3%),较B组16例(53.3%)心电学变化及心脏事件发生率低。结论:厄贝沙坦对冠心病患者可能降低围术期cTnI上升程度,减少心电学变化及心脏事件发生率,对心肌具有保护作用。     

Long-term outcome of infrapopliteal catheter-based intervention for critical limb ischemia

CONTEXT:

Percutaneous treatment of tibioperoneal occlusive disease is associated with decreased morbidity compared with bypass surgery. The long-term patency and limb salvage rates are not well documented.

AIMS:

To evaluate the long-term outcome of endoluminal interventions for tibioperoneal lesions.

METHODS:

A retrospective study was performed to determine the outcomes of patients undergoing infrapopliteal catheter-based intervention for critical limb ischemia. Collected data included demographics, comorbidities, clinical presentation, pre- and postintervention noninvasive vascular measurements (segmental pressure and waveforms, and ankle-brachial index [ABI]), type of intervention, limb loss rate, patient follow-up and need for surgical revascularization. Statistical analysis was performed with the two-tailed t test. P<0.05 was considered significant; results were reported as mean ± SD. Cox regression analysis and Kaplan-Meier limb survival analysis were performed to demonstrate freedom from amputation over time.

RESULTS:

Thirty-five patients underwent intervention from 2003 to 2008; technical success was achieved in 26 patients (75%). Arterial segmental pressure studies revealed a significant increase in ABI – preprocedure ABI was 0.62±0.24 versus a postintervention ABI of 0.81±0.29 (P=0.02). The limb salvage rate was 63% during the follow-up period. Limb salvage was better for patients who underwent isolated infrapopliteal intervention versus combined above and below the knee intervention.

CONCLUSION:

Percutaneous interventions for tibioperoneal occlusive disease offer an acceptable limb salvage rate and may be the preferred initial treatment for critical limb ischemia.     

老年下肢动脉硬化泛大西洋共识D级病变患者的腔内治疗

目的探讨老年下肢动脉硬化泛大西洋介入学会(TASC)Ⅱ-D级病变患者腔内治疗的技术特点及疗效。方法选取50例我院收治并进行腔内治疗的老年下肢动脉硬化TASCⅡD级病变患者(64条下肢),对腔内治疗的技术方法、疗效、并发症、术后随访等进行总结分析。结果成功进行腔内治疗58条下肢,技术成功率90.6%(58/64),其中单纯行球囊扩张10条下肢,球囊扩张联合支架置入48条下肢。围手术期发生并发症5例,发生率为10.0%(5/50),包括穿刺处假性动脉瘤形成1例、心力衰竭1例、造影剂肾病1例、动脉穿孔2例。围手术期无死亡患者,术前与术后7 d踝肱指数比较,差异有统计学意义(0.40±0.11 vs 0.78±0.14,P<0.001)。术后12、24个月分别随访50条和30条下肢,Ⅰ期通畅率分别为84.0%(42/50)和66.7%(20/30),Ⅱ期通畅率分别为88.0‰(44/50)和76.7%(23/30),24个月保肢率为100%(30/30)。结论对老年患者下肢动脉硬化TASCⅡ-D级病变进行腔内治疗,技术成功率高、保肢率高、并发症少、近期临床效果良好,远期疗效需继续观察。     

Tibioperoneal arterial lesions and critical foot ischaemia: successful management by the use of short vein grafts and percutaneous transluminal angioplasty

BACKGROUND: In a substantial number of mainly diabetic patients isolated crural arterial lesions are found to be the underlying cause for severe ischaemic foot lesions. Without revascularisation, patients with this specific occlusion pattern will inevitably face major amputation. To attain limb salvage in this setting, since the early eighties short vein grafts were used to bypass the occluded infrapopliteal arteries. More recently, percutaneous transluminal angioplasty (PTA) was also attempted to avoid limb loss in selected patients. PATIENTS AND METHODS: Since May 1986 in 125 patients 130 autologous bypass grafts from the BK-popliteal artery or the proximal tibioperoneal arteries to malleolar vessels were performed in the presence of extended crural arterial occlusions and critical foot ischaemia (rest pain 3, tissue loss 127). In another series in 89 limbs (rest pain 5, tissue loss 84) of 84 patients PTA was done to treat 168 focal stenoses of > 50% diameter reduction and 11 short occlusions in a total of 135 crural arteries. RESULTS: Using life-table analysis, primary and secondary cumulative patency rates for short vein grafts with distal graft origin were 90% and 98% at 30 days, 76% and 83% at one year and 46% and 49% at seven years, respectively. The corresponding limb salvage rates amounted to 95%, 80% and 63%. Initial complete or partial technical success after PTA of crural arteries could be obtained in 93%: The limb salvage rates achieved were 95% at 30 days, 82% at one year and 63% at six years. CONCLUSION: Our results suggest that--depending on the extent of lesions--both short vein grafts as well as PTA are successful complementary treatment modalities to avoid limb loss in predominantly diabetic patients with infrapopliteal artery disease and critical ischaemia.     

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。