超声介入治疗在血管疾病中的应用

血管介入治疗创伤小、疗效好、恢复快, 近年来在临床中的应用越来越广泛, 但传统血管介入治疗多采用数字减影血管造影等放射学引导, 不适于碘造影剂过敏或禁忌证的患者。而超声引导下血管介入治疗可避免以上缺陷, 且成本低、方便易行。目前该技术主要应于下肢动脉狭窄或闭塞、肾动脉狭窄、腹主动脉瘤、医源性假性动脉瘤等动脉疾病, 布加综合征、胡桃夹综合征、左髂静脉压迫综合征、大隐静脉曲张、静脉畸形等静脉疾病, 以及下腔静脉滤器置入、导管接触性溶栓等微创治疗。其治疗成功的基础和关键是常规超声图像能够清晰显示操作通路和病灶区域, 并保持图像稳定性, 同时导丝和球囊等血管内操作器械在超声图像上能够实时清晰显示。超声引导下的血管介入治疗还可在术中对治疗后的病变血管进行实时血流动力学评估, 从而评价介入治疗效果。此外, 血管内超声可更加直观显示血管内部结构, 使常规超声介入引导难度大的操作得以成功开展, 拓宽了超声介入的治疗领域。

Application of Ultrasonic Intervention in the Treatment of Vascular Diseases

In recent years, vascular interventional therapy has been widely used in clinical practice due to its less trauma, better curative effect and faster recovery. However, traditional vascular interventional therapy is often guided by radiology such as digital subtraction angiography, which is not suitable for patients with iodine contrast agent allergy or contraindications. Ultrasound-guided vascular interventional therapy can avoid the above defects, and it is low-cost and convenient. At present, this technique is mainly used in the minimally invasive treatment of arterial stenosis or occlusion of the lower extremity, renal artery stenosis, abdominal aortic aneurysm, iatrogenic pseudoaneurysm, Budd-Chiari syndrome, walnut clip syndrome, left iliac vein compression syndrome, great saphenous varicose vein, venous malformation, inferior vena cava filter implantation, catheter contact thrombolization, and so on. The basis and key to the success of the treatment is that the conventional ultrasound image can clearly display the operating pathway and lesion area, and maintain image stability. At the same time, the guidewire and balloon and other intravascular operating instruments can be dis-played clearly on the ultrasound image in real time. Ultrasound-guided vascular interventional therapy can also evaluate the vascular segment of the lesion and estimate the effect of interventional therapy in real time. In addition, intravascular ultrasound can more intuitively display the internal structure of blood vessels, so that the difficult operation guided by conventional ultrasound intervention can be successfully carried out, which broadens the field of ultrasound interventional therapy.