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1、最新(PPT)-长段股浅动脉闭塞腔内治疗-药学医学精品资料前言TASCII-2007TypeClesions-Multiplestenosesorocclusionstotaling>15cmwithorwithoutheavycalcification-RecurrentstenosesorocclusionsthatneedtreatmentaftertwoendovascularinterventionsTypeDlesions-ChronictotalocclusionsofCFAorSFA(>20cm,in
2、volvingthepoplitealartery)-Chronictotalocclusionofpoplitealarteryandproximaltrifurcationvessels“BypassbetterthanEndovascular”CharingCross33NewTASCguidelinesaresettorecommendanendovascularfirststrategyevenforTASCDlesions.JohannesLammer,Vienna,Austria,toldCX33del
3、egatesthatan“endovascularfirst”strategyforallTASClesionswasrecommendedintheproposedupdatetotheTASCIIguidelines.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
4、主动脉术后ABI:0.81球囊辅助的SIAABI:左0.5右0Admiral6/60mm腘动脉逆行穿刺,球囊顺行撕开内膜Admiral4/120mm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Recross182/80V18Recross2/80Batam2.5/80Everflex6/200Frontrunner辅助右下肢跛行200米,ABI:0.3ABI:1.0Outback导管辅助的SIASilverhawk处理支架长段闭塞SFA的腔内治疗现状冷冻
5、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。KarthikS,TuiteDJ,NicholsonAA,etal.Cryoplastyforarterialrestenosis.EurJVascEndovascSurg.2007;33:40–43.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。MauriL,BonanR,WeinerBH,etal.Cuttingballoonangioplastyforthepreventionofrestenosis:resul
6、tsoftheCuttingBalloonGlobalRandomizedTrial.AmJCardiol.2002;90:1079–1083.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。RamaiahV,GammonR,KieszS,etal.MidtermoutcomesfromtheTALONRegistry:treatingperipheralswithSilverHawk:outcomescollection.JEndovascTher.2006;13:592–602.激光消
7、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。ScheinertD,LairdJR,SchroderM,etal.Excimerlaser-assistedrecanalizationoflong,chronicsuperficialfemoralarteryocclusions.JEndovascTher.2001;8:156–166.药物涂层支架:SIROCCOII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。DudaSH,
8、BosiersM,LammerJ,etal.Sirolimus-elutingversusbarenitinolstentforobstructivesuperficialfemoralarterydisease:theSIROCCOIItrial.JVascIntervRadiol.2005;16:331–338.“腔内治疗操作成功率超过82