开放手术联合腔内治疗严重下肢缺血疾病.ppt

开放手术联合腔内治疗严重下肢缺血性疾病,天津市人民医院栗力,下肢动脉缺血腔内治疗天津医科大学附属人民医院血管科栗力,2007年2月至2008年5月天津市人民医院血管外科收治下肢动脉缺血患者共150例，介绍部分接受外科手术和腔内血管成形术的典型病例。,1、短段下肢动脉狭窄及闭塞病变,2、长段动脉闭塞病变,术中,术后,术前,术后6天,3、股动脉、腘动脉完全闭塞,股动脉内膜剥脱,术前,术后20小时,4、双髂动脉及左股浅动脉闭塞,左髂动脉未能探通，右髂总动脉支架置入术，同期行股-股、股-腘动脉人工血管旁路术。,截趾术后愈合良好,截趾术后愈合良好,术后5个月出现左下肢发凉、麻木及疼痛，CTA提示人工血管内血栓形成。行人工血管切开取栓及腔内治疗。,取栓后造影显示远端吻合口狭窄,5、人工血管旁路术后急性血栓形成,双股-腘动脉人工血管旁路术、左侧输出道动脉段内膜剥脱术。,术后20小时出现左下肢发凉、远端动脉搏动消失，DSA检查，证实血栓形成，急症行人工血管切开取栓及血管成形支架置入术。,取栓后腔内治疗,讨论,1、延时造影无输出道股腘动脉长段闭塞应如何处理？2、输出道多段病变的股腘旁路术，围手术期移植物急性血栓形成的处理？3、同期贯序旁路术后移植物闭塞的好发部位？,谢谢,Endovasculartreatmentforischemicdiseaseinlowerlimb,天津市人民医院栗力,EndovasculartreatmentforischemicdiseaseinlowerlimbLiLiVasculardepartmentUnionmedicalcentre,Tianjin,Thereare150casestreatedinvasculardepartmentinUnionmedicalcenterTianjinfromFeb.2007toMay2008,Illshowcasesometypicalcasestreatedwithopenandinterventionalangioplasty.,1、ShortsegmentarterialstenosisandocclusioninLowerextremity,2、Longsegmentarterialblockage,postoperation,preoperation,6dayslater,3、EntireocclusioninSFAandpoplitealartery,EndarterectomyinSFA,preoperation,20hourslater,4、BilateraliliacandLSFAocclusion,failedinleftiliacarterialvascularization,stentingwasperformedinrightcommoniliac,femoral-femoralbypassandfemoral-poplitealartificialgraftbypasswereperformedsimutaneously.,Goodresultaftertheamputation,截趾术后愈合良好,Presentedwithcoldandnumbinleftlegfivemonthslateraftertheoperation,ThrombosiswasconfirmedingraftbyCTA.Graftthrombectomyandendovasculartreatmentwasperformed.,Stenosiswasshownbyangiogramatdistalanastomosicsiteafterthethrombectomy.,5、Acutethrombosisingraftafteroperation.,BilateralSFA-PAbypass,endarterectomywasperformedinleftoutflowartery.,Coldandpulselesswerepresentedleftleg.ThrombosiswasconfirmedingraftbyDSA.Thrombectomyandstentingwasperformedurgently.,Endovasculartreatmentwasperformedafterthrombectomy,Discussion,1、Howtotreatthelongsegmentocclusivediseasewithoutoutflowinangiogram?2、TreatmentofacutethrombosisinSFA-PA