开放手术联合腔内治疗严重下肢缺血疾病

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1、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

2、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Endovasculartreatmentforisch

3、emicdiseaseinlowerlimb天津市人民医院栗力EndovasculartreatmentforischemicdiseaseinlowerlimbLiLiVasculardepartmentUnionmedicalcentre,TianjinThereare150casestreatedinvasculardepartmentinUnionmedicalcenterTianjinfromFeb.2007toMay2008,I‘llshowcasesometypicalcasestreatedwithopenandi

4、nterventionalangioplasty.1、ShortsegmentarterialstenosisandocclusioninLowerextremity2、Longsegmentarterialblockagepostoperationpreoperation6dayslater3、EntireocclusioninSFAandpoplitealarteryEndarterectomyinSFApreoperation20hourslater4、BilateraliliacandLSFAocclusionfailed

5、inleftiliacarterialvascularization,stentingwasperformedinrightcommoniliac,femoral-femoralbypassandfemoral-poplitealartificialgraftbypasswereperformedsimutaneously.Goodresultaftertheamputation截趾术后愈合良好Presentedwithcoldandnumbinleftlegfivemonthslateraftertheoperation,Thr

6、ombosiswasconfirmedingraftbyCTA.Graftthrombectomyandendovasculartreatmentwasperformed.Stenosiswasshownbyangiogramatdistalanastomosicsiteafterthethrombectomy.5、Acutethrombosisingraftafteroperation.BilateralSFA-PAbypass,endarterectomywasperformedinleftoutflowartery.Cold

7、andpulselesswerepresentedleftleg.ThrombosiswasconfirmedingraftbyDSA.Thrombectomyandstentingwasperformedurgently.EndovasculartreatmentwasperformedafterthrombectomyDiscussion1、Howtotreatthelongsegmentocclusivediseasewithoutoutflowinangiogram?2、Treatmentofacutethrombosis

8、inSFA-PAbypasswithmultiplediseaseinoutflow?3、Whereistheregionusuallyblockedaftersequentgraftbypass?Thankyou