長(zhǎng)段股淺動(dòng)脈閉塞腔內(nèi)治療.ppt

長(zhǎng)段股淺動(dòng)脈閉塞腔內(nèi)治療,王峰 紀(jì)東華 大連醫(yī)科大學(xué)附屬第一醫(yī)院介入科,前 言,TASC II -2007 Type C lesions - Multiple stenoses or occlusions totaling 15 cm with or without heavy calcification - Recurrent stenoses or occlusions that need treatment after two endovascular interventions Type D lesions - Chronic total occlusions of CFA or SFA(20 cm, involving the popliteal artery) - Chronic total occlusion of popliteal artery and proximal trifurcation vessels,“Bypass better than Endovascular”,Charing Cross 33,New TASC guidelines are set to recommend an endovascular first strategy even for TASC D lesions. Johannes Lammer, Vienna, Austria, told CX 33 delegates that an “endovascular first” strategy for all TASC lesions was recommended in the proposed update to the TASC II guidelines.,大連醫(yī)科大學(xué)附屬一院,2008年1月-2010年2月 143例 失訪：30例 死亡：5例 二次手術(shù)：39例 截肢：6例,腔內(nèi)治療的2年保肢率：94.2%；一期通暢率：59.8%。,期待更多中心聯(lián)合的結(jié)果！,TASC C&D Lesions for SFA,腔內(nèi)治療的方法 內(nèi)膜下成型術(shù)：a.順行 b.逆行 c.順+逆行 器械輔助內(nèi)膜下成型術(shù)：a.導(dǎo)絲穿刺 b.球囊輔助 c. Outback導(dǎo)管 器械輔助開(kāi)通：Frontrunner 內(nèi)膜旋切術(shù),SIA-經(jīng)對(duì)側(cè)或同側(cè)股動(dòng)脈順行,SIA-經(jīng)腘動(dòng)脈逆行,SIA-經(jīng)患側(cè)腘動(dòng)脈及健側(cè)股動(dòng)脈順行-逆行,SIA-經(jīng)肱、腘動(dòng)脈順行-逆行,導(dǎo)絲穿刺輔助的SIA,右下肢靜息痛，ABI: 0.10,既往3月前在外院行髂動(dòng)脈支架成型術(shù)，現(xiàn)發(fā)現(xiàn)支架遠(yuǎn)端在IIA。,經(jīng)腘動(dòng)脈逆行無(wú)法返回,一周后,以sv5導(dǎo)絲硬頭髂總動(dòng)脈穿刺回真腔，再以progreat導(dǎo)管跟入腹主動(dòng)脈,術(shù)后ABI:0.81,球囊輔助的SIA,ABI：左 0.5 右 0,Admiral 6/60mm,腘動(dòng)脈逆行穿刺,球囊順行撕開(kāi)內(nèi)膜,Admiral 4/120mm,導(dǎo)絲順行進(jìn)入逆行的導(dǎo)管,術(shù)后造影結(jié)果,雙球囊輔助導(dǎo)絲穿刺的SIA,右足2、3趾破潰，靜息痛；ABI:0,順行開(kāi)通困難,Recross 18 2/80 V18,Recross 2/80,Batam 2.5/80,Everflex 6/200,Frontrunner 輔助,右下肢跛行200米，ABI：0.3,ABI:1.0,Outback導(dǎo)管輔助的SIA,Silverhawk 處理支架長(zhǎng)段閉塞,SFA的腔內(nèi)治療現(xiàn)狀,冷凍球囊： Karthik 等認(rèn)為冷凍球囊對(duì)再狹窄病例的通暢率沒(méi)有顯著改善。 Karthik S, Tuite DJ, Nicholson AA, et al.Cryoplasty for arterial restenosis. Eur J Vasc Endovasc Surg. 2007;33:4043. 切割球囊：Mauri等認(rèn)為切割球囊比較普通球囊而言并沒(méi)有顯著降低再狹窄的療效。 Mauri L, Bonan R, Weiner BH, et al. Cutting balloon angioplasty for the prevention of restenosis: results of the Cutting Balloon Global Randomized Trial. Am J Cardiol.2002;90:10791083.,內(nèi)膜旋切：TALON研究顯示：內(nèi)膜旋切配合藥物治療可能會(huì)降低再狹窄的發(fā)生率。 Ramaiah V, Gammon R, Kiesz S, et al.Midterm outcomes from the TALON Registry: treating peripherals with SilverHawk: outcomes collection.J Endovasc Ther. 2006;13:592602. 激光消融：Scheinert等報(bào)道：激光消融的SFA的一年通常率是33.6%，所以在處理再狹窄上無(wú)優(yōu)勢(shì)。 Scheinert D, Laird JR, Schroder M, et al.Excimer laser-assisted recanalization of long,chronic superficial femoral artery occlusions.J Endovasc Ther. 2001;8:156166.,藥物涂層支架： SIROCCO II研究顯示其半年的再狹窄率為0%，對(duì)比裸支架7.7%?？赡軙?huì)是降低再狹窄的一個(gè)好選擇。 Duda SH, Bosiers M, Lammer J, et al. Sirolimus-eluting versus bare nitinol stent for obstructive superficial femoral artery disease: the