长段股腘动脉硬化闭塞的腔内治疗初步经验分析

目的 评价血管腔内治疗长段股咽动脉硬化闭塞的临床效果.方法 2006年4月～2009年1月采用血管腔内治疗长段股咽动脉硬化闭塞10例(共14条肢体),术中同时行股咽动脉血管腔内球囊扩张成形术及支架植入术.结果 手术技术成功率为90%,放置12个支架,术后12个月通畅率为70%,术后血管再狭窄率30%.结论 血管腔内成形治疗长段股咽动脉硬化闭塞是一种安全有效的治疗方法.     

血管腔内支架成形术治疗下肢动脉硬化闭塞症45例

目的探讨血管腔内支架成形术治疗下肢动脉硬化闭塞症的疗效。方法采用经皮穿刺股动脉或切开动脉直视下穿刺,造影明确病变动脉部位及病变长度后,利用导丝或超声消融导管开通闭塞段,球囊导管行扩张成形后置入血管内支架。结果45例(53条患肢)血管腔内支架均释放成功,踝肱指数由0.36±0.14增至术后7 d 0.77±0.21(t=2.397,P=0.021),45例随访6~54个月,平均23个月,一期肢体通畅率90.6%(48/53)。结论血管腔内支架成形术操作简便、微创、安全是治疗下肢动脉硬化闭塞症的有效方法。     

下肢动脉硬化闭塞症的腔内治疗

下肢动脉硬化闭塞症主要累及髂股动脉、股腘动脉和膝下动脉,目前主要的治疗方式是腔内治疗,由于三段动脉解剖的差异,其腔内治疗原则和效果是不同的.主髂动脉硬化闭塞的腔内治疗的通畅率不低于外科手术,已成为首选方式;股腘动脉硬化闭塞因其发病率高,腔内治疗的通畅率不能令人满意,已成为研究热点;膝下动脉闭塞的腔内治疗仍处在探索之中,...     

腔内介入治疗长段股浅动脉硬化闭塞症26例疗效分析

2009年11月—2010年1月采用血管腔内介入治疗股浅动脉长段硬化闭塞患者26例共30条患肢,病变长度10.3~22.8 cm,平均15.89 cm,主要症状为静息痛,合并溃疡或趾端坏疽者15例。本组30条患肢均行腔内介入治疗,其中股浅动脉闭塞段单纯球囊扩张6条,球囊扩张支架植入21条,术中导丝无法通过闭塞段,导致介入失败3条。股浅动脉闭塞段介入技术成功率86.7%,术后患肢静息痛消失、溃疡面积减小,围手术期截肢1例,截肢率3.3%。腔内介入治疗股浅动脉长段硬化闭塞症是一种安全有效的方法。     

下肢动脉硬化闭塞症腔内治疗

下肢动脉硬化闭塞症（ASO）是一种主要由动脉粥样硬化引起的疾病,发病率、病死率较高,严重影响病人生活质量。根据下肢ASO病人病情严重度及病变部位而制定的Fontain、Rutherford分期及TASCⅡ分级标准在临床治疗方案决策及预后估计中起到重要作用。下肢ASO病人的治疗方案根据病变解剖位置的不同而有所不同,同时也受到病人合并症以及手术医师水平的限制。目前下肢ASO的手术治疗以血管重建为主,其中腔内手术为大多数病人首选治疗方案。     

腔内介入治疗下肢动脉硬化闭塞症的疗效观察

目的评价腔内介入治疗下肢动脉硬化闭塞症(ASO)的疗效。方法回顾分析我院2009年12月至2011年12月腔内治疗的32例(43条患肢)下肢ASO患者的临床资料,并随访其疗效。结果 30例(40条患肢)患者治疗后临床症状消失或较前明显减轻,治疗后踝肱指数(ABI)0.62±0.15,较术前(0.35±0.15)明显提高(P<0.05)。随访时间3～15个月,13例患者仍存在间歇性跛行,2例术后3个月对侧股浅动脉以远部位动脉狭窄闭塞,经皮腔内血管成形术治疗后症状缓解,其他病例症状缓解。结论腔内介入治疗下肢ASO短期疗效满意,远期效果尚待进一步观察。     

血管腔内成形术治疗膝下动脉硬化闭塞症

近年来血管腔内成形术（PTA）治疗下肢动脉硬化闭塞症（ASO）迅速发展,多种新型介入材料相继问世并且应用于临床,血管腔内治疗的范围已从大中血管向中小血管扩展,腘动脉及远侧胫、腓动脉的治疗也在广泛开展。大量文献报道,PTA治疗膝下ASO成功率高,并发症少,保肢率高,可以作为膝下ASO特别是重症肢体缺血的首选。     

腔内治疗下肢动脉硬化闭塞症76例临床分析

目的：讨论腔内成形术在下肢动脉硬化闭塞症（ASO）治疗中的应用。方法：回顾2008年5月—2010年4月收治的76例ASO病例,分析Fontaine分期及糖尿病对手术疗效的影响。结果：技术成功61例,总体技术成功率80.3%。FontaineⅡ期组39例,技术成功36例（92.3%）,明显高于Ⅲ期组（82.1%）和Ⅳ期组（22.2%）;合并糖尿病组22例（28.9%）,技术成功15例（68.2%）,低于无糖尿病组（85.2%）。结论：腔内成形术是治疗ASO的有效微创手术方法,积极腔内手术干预有助提高早期患者手术成功率,同时对晚期患者可有效改善症状。     

股腘动脉慢性长段闭塞腔内治疗134例临床分析

目的观察TASCⅡC、D型股胭动脉慢性长段闭塞腔内治疗的临床疗效,总结腔内治疗相关并发症和防治方法。方法2009年1月至2010年12月,134例（172条下肢）TASCⅡC、D型股胴动脉闭塞患者接受腔内治疗。回顾性分析技术成功率、患肢术后临床症状、踝肱指数（ankle brachial index,ABI）变化、并发症发生率和通畅率。结果技术成功率90．7％。43条患肢（83条次）出现并发症（27．6％）。其中动脉夹层29条（34．9％）,动脉穿孔11条（13．3％）,动脉栓塞8条（9．6％）,穿刺部位血肿16条（19．3％）,穿刺点假性动脉瘤5条（6．0％）,急性动脉血栓形成3条（3．6％）,造影剂过敏反应3条（3．6％）,尿路出血2条（2．4％）和心脑血管意外6条（7．2％）。平均随访13．1个月。术后12个月的一期通畅率、辅助通畅率和二期通畅率分别为61．1％、70．2％、81．7％。结论TASCⅡC、D型股胭动脉闭塞腔内治疗是一种安全有效的方法。熟练的腔内操作技术,及时正确的并发症处理和规范的术后随访是提高治疗成功率和维持动脉长期通畅的关键。     

膝下动脉闭塞症的腔内治疗

目的探讨腔内术对膝下动脉闭塞疾病的治疗价值。方法回顾性分析2006年2月至2008年5月复旦大学附属中山医院血管外科收治的86例患有膝下动脉闭塞症的住院病人的病史资料和术后随访资料。结果86例病人（90条患肢）经经皮腔内血管成形术（PTA）治疗,82条患肢获得影像学成功（残留狭窄率＜30%）。技术成功率为911%（82/90）。术前1周和术后1周行下肢节段测压,踝肱指数（ABI）由术前的034±016提高到085±023。1年累计初次通畅率为612%,24月累积初次通畅率为495%,肢体保全率978%,存活率978%。结论PTA治疗膝下动脉闭塞症临床成功率高,并发症少,保肢率高,可以作为膝下动脉闭塞特别是重症肢体缺血的首选。     

TASCC、D级髂动脉病变的腔内治疗

目的探讨腔内技术治疗TASCC、D级髂动脉病变的可行性及近期疗效。方法回顾性总结77例TASCC、D级(共89条髂动脉)行腔内治疗患者的临床资料;其中TASCC级病变63例,TASCD级病变14例。结果 3条髂动脉未能开通闭塞段,开通率为96.6%。23条髂动脉行单纯经皮血管腔内成形术治疗,其余63条髂动脉置入支架。共置入支架104枚。踝肱指数由术前0.20±0.14增至术后7天的0.71±0.21(P=0.02)。主要并发症发生率3.9%。64例(78条髂动脉)患者获得随访,随访率83.1%;平均随访时间23(6～53)个月,其1、2、4年肢体通畅率分别为88%、84%和70%。结论腔内治疗TASCC、D级髂动脉病变安全微创,其短期效果较好。     

介入治疗下肢动脉疾病:现状与挑战

随着技术与材料的进步,介入治疗已成为治疗下肢动脉疾病(LEAD)的主要手段,但中远期疗效尚不理想,对于选择介入治疗策略亦缺乏相应规范化指导。当前应继续推进介入器械改进与创新,以解决现有介入治疗策略存在的问题;开展更多高质量临床研究,为个体化治疗决策提供理论依据。本文就介入治疗的LEAD现状与挑战进行述评。     

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目的探讨TASC-C、D型慢性主髂动脉病变腔内介入治疗的操作成功率、安全性和近期通畅率。方法2005年4月至2006年12月,上海交通大学医学院附属仁济医院血管外科采用血管腔内介入方法治疗TASC-C、D型慢性主髂动脉病变病人14例,其中2例接受了二期远端流出道重建。结果无围手术期死亡。血管腔内介入治疗成功率为93.7%,并发症发生率为7.1%。随访2~20个月(平均6.5个月),病人症状无加重或复发。结论血管腔内介入治疗TASC-C、D型慢性主髂动脉病变具有较高的操作成功率,围手术期并发症少,近期效果确切,其长期疗效尚须进一步随访观察。     

Endovascular treatment of hepatic artery thrombosis following liver transplantation

Hepatic artery thrombosis (HAT) is the most frequent vascular complication following orthotopic liver transplantation. Urgent retransplantation has been considered as the mainstay therapy. Surgical revascularization is an effective alternative in asymptomatic patients. Endovascular therapies including intra‐arterial thrombolysis, percutaneous transluminal angioplasty (PTA), and stent placement have shown encouraging results in recent years; however, their use remains controversial because of potential risk of hemorrhage. Until June 2009, 69 cases were published in 16 reports describing therapeutic potential of endovascular modalities. Interventions were performed as early as within 4 h to as late as 120 days in patients ranging from 4 months to 64 years of age. Majority of published reports suggested the use of urokinase. Thrombolysis was successful in 47 out of 69 (68%) patients. Bleeding was the most common complication including fatal intra‐abdominal hemorrhage in three patients. Twenty‐nine out of 47 (62%) patients underwent further intervention in the form of PTA, stenting, or both. The follow‐up patency ranged from 1 month to 26 months. In conclusion, whenever possible, efforts should be made to rescue the liver grafts through urgent revascularization (surgical and/or endovascular) depending on patient’s condition and interventional expertise at the transplant center; reserving the option of retransplantation for failure, complications, and cases with severe clinical symptoms or allograft dysfunction.     

盐酸沙格雷酯治疗慢性下肢动脉缺血的疗效观察

目的 评价盐酸沙格雷酯治疗慢性下肢动脉缺血的临床疗效.方法 选择未施行血管移植或血管旁路搭桥手术或(和)介入治疗的动脉粥样硬化、血栓闭塞性脉管炎、糖尿病足伴有下肢间歇性跛行、冷感、疼痛、溃疡等缺血症状的患者892例为治疗对象.盐酸沙格雷酯剂量为100 mg/次,3次/d,疗程为8周.观察用药前后的症状改善程度、综合疗效以及药物不良反应.结果 间歇性跛行、冷感、疼痛、溃疡的改善率分别为96.9％、97.1％、89.0％和86.9％,3种疾病总有效率(显效+良好)83.5％.81例(9.1％)有轻度不良反应,7例皮疹,21例轻度恶心,53例胃部不适,对症治疗后可缓解,不需停药.结论 盐酸沙格雷酯治疗慢性下肢动脉缺血性疾病是一种安全、有效的药物.     

血管内开通微孔道型慢性颈内动脉闭塞2例

病例1:患者男,75岁,因“发作性头晕2个月”入院;高血压病史20年,否认糖尿病、冠心病病史,无烟酒嗜好。查体及实验室检查无明显异常。血管造影:Ⅲ型主动脉弓型,右侧颈内动脉C1段起始部次全闭塞,病变段呈“蜂窝”状或“网格”状改变(即存在微孔道),前向血流缓慢(图1A);影像学诊断:微孔道型颈内动脉慢性闭塞。行血管内开通术,将8F导引导管置于右侧颈总动脉远端,送入多功能导管(5F,125 cm),使其头端置位于右侧颈内动脉起始部,引入微导管(Ethelon-10)、微导丝(Pilot 50)组合,尝试沿微孔道通过病变失败;引入2.0 mm×15 mm球囊、微导丝(Pilot 50)组合,在小球囊支撑下,微导丝经反复尝试成功穿过(未完全循微孔道)病变段,并向上到达右侧颈内动脉C1远端(图1B),但球囊未能跟进;换用1.25 mm×15 mm球囊到达病变段并进行扩张后,再以2.0 mm×15 mm小球囊重复扩张。沿微导丝送入脑保护伞(Spider,5 mm)至右侧颈内动脉C1远段,沿保护伞导丝引入5 mm×30 mm球囊再次扩张病变段血管(图1C),最后植入颈动脉支架(Protege 8~6 mm×40 mm)(图1D)。术后血管造影示颈内动脉成功再通,患者头晕症状消失。     

外伤性下肢动脉损伤77例治疗效果分析

目的探讨外伤导致的下肢动脉损伤的诊疗方法及临床效果。方法回顾性分析2013年1月至2021年6月宜昌市中心人民医院血管外科收治的77例外伤性下肢动脉损伤患者的临床资料。男性65例, 女性12例, 平均年龄47.4岁(范围:7～75岁)。77例患者中, 开放性损伤56例(72.7%), 闭合性损伤21例(27.3%);损伤累及髂动脉9例(11.7%), 股总动脉7例(9.1%), 股浅动脉1例(1.3%), 腘动脉11例(14.3%), 膝下动脉49例(63.6%)。分析患者的治疗方式和临床效果。结果 77例患者中, 1例累及髂内动脉的骨盆骨折患者和1例累及股总动脉的多发伤患者, 因损伤严重, 于术前因循环衰竭死亡;75例患者接受血管相关手术, 其中67例行开放手术, 包括动脉结扎术24例、动脉重建术40例、覆膜支架植入术1例、一期截肢术2例;8例行动脉栓塞术。总体病死率为6.5%(5/77), 均为闭合性损伤, 除2例术前死亡患者外, 3例累及髂内动脉的骨盆骨折患者虽接受髂内动脉栓塞术, 但因复合损伤严重, 术后因多器官功能衰竭死亡。截肢患者8例(10.4%, 8/77), 5例为闭合...     

Surgical and endovascular treatment of hepatic arterial complications following liver transplant

Vascular complications after liver transplantation increase post‐operative morbidity and contribute to the incidence of retransplantation. Vascular complications comprise arterial, caval, and portal venous pathology, with the majority of complications being arterial in etiology, including anastomotic stricture, pseudoaneurysm, and thrombosis. There are two major therapeutic options for the treatment of these arterial complications: endovascular intervention and surgery. The former includes intra‐arterial thrombolysis, embolization, percutaneous transluminal angioplasty, and stent placement. The latter includes thrombectomy, reanastomosis, and retransplantation. Although surgical treatment has been considered the first choice for management in the past, advances in endovascular intervention have increased and make it a viable therapeutic option following orthotopic liver transplantation. This review focuses on the role of surgical and endovascular therapy in the management of hepatic arterial complications after liver transplantation.     

Future perspectives in the treatment of femoro-popliteal arterial occlusions

Femoro-popliteal occlusive disease represents the most frequent localization of atherosclerosis in the lower extremities. Treatment of this disease has changed remarkably in the last decade. A definite treatment strategy has still to be established. The pathophysiology is described. A general overview of the state-of-the art treatment modalities and the most recent developments is given. This is divided into non-interventional preventive and supportive therapy, endovascular interventional therapy, and surgical interventional therapy. The development of medical therapy has expanded enormously and is progressing still. In the wide range of interventional treatment modalities, there has been a change from invasive bypass surgery to more refined techniques like endarterectomy and percutaneous endovascular therapy. This trend towards restoring the patency of the artery using the vessel wall itself as a conduit, leads to a term encompassing all these treatment modalities, known as restorative intervention. Peri-procedural risks of restorative interventions are of a much lesser degree compared to bypass surgery. Reports of patency rates show a steady increase. It is expected that patency rates will eventually equal or even surpass those of bypass surgery. In conclusion, a treatment strategy for femoro-popliteal occlusions in the future is proposed as follows: the first line of interventional therapy in femoro-popliteal occlusions should be a restorative intervention. With adequate adjuvant medical therapy and sufficient monitoring, this will be the definite treatment for the majority of patients. Bypass surgery should be regarded as the second line of interventional therapy and should be reserved for those patients in whom restorative interventions fail.