长段股浅动脉闭塞腔内治疗.ppt

长段股浅动脉闭塞腔内治疗,王峰 纪东华 大连医科大学附属第一医院介入科,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.,大连医科大学附属一院,2008年1月-2010年2月 143例 失访：30例 死亡：5例 二次手术：39例 截肢：6例,腔内治疗的2年保肢率：94.2%；一期通畅率：59.8%。,期待更多中心联合的结果！,TASC C&D Lesions for SFA,腔内治疗的方法 内膜下成型术：a.顺行 b.逆行 c.顺+逆行 器械辅助内膜下成型术：a.导丝穿刺 b.球囊辅助 c. Outback导管 器械辅助开通：Frontrunner 内膜旋切术,SIA-经对侧或同侧股动脉顺行,SIA-经腘动脉逆行,SIA-经患侧腘动脉及健侧股动脉顺行-逆行,SIA-经肱、腘动脉顺行-逆行,导丝穿刺辅助的SIA,右下肢静息痛，ABI: 0.10,既往3月前在外院行髂动脉支架成型术，现发现支架远端在IIA。,经腘动脉逆行无法返回,一周后,以sv5导丝硬头髂总动脉穿刺回真腔，再以progreat导管跟入腹主动脉,术后ABI:0.81,球囊辅助的SIA,ABI：左 0.5 右 0,Admiral 6/60mm,腘动脉逆行穿刺,球囊顺行撕开内膜,Admiral 4/120mm,导丝顺行进入逆行的导管,术后造影结果,双球囊辅助导丝穿刺的SIA,右足2、3趾破溃，静息痛；ABI:0,顺行开通困难,Recross 18 2/80 V18,Recross 2/80,Batam 2.5/80,Everflex 6/200,Frontrunner 辅助,右下肢跛行200米，ABI：0.3,ABI:1.0,Outback导管辅助的SIA,Silverhawk 处理支架长段闭塞,SFA的腔内治疗现状,冷冻球囊： Karthik 等认为冷冻球囊对再狭窄病例的通畅率没有显著改善。 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等认为切割球囊比较普通球囊而言并没有显著降低再狭窄的疗效。 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.,内膜旋切：TALON研究显示：内膜旋切配合药物治疗可能会降低再狭窄的发生率。 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等报道：激光消融的SFA的一年通常率是33.6%，所以在处理再狭窄上无优势。 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.,药物涂层支架： SIROCCO II研究显示其半年的再狭窄率为0%，对比裸支架7.7%。可能会是降低再狭窄的一个好选择。 Duda SH, Bosiers M, Lammer J, et al. Sirolimus-eluting versus bare nitinol stent for obstructive superficial femoral artery disease: the