目的评价内膜下血管成形术(SIA)治疗下肢动脉硬化闭塞症的技术可行性和近期临床效果。方法从2003年12月至2005年12月2年期间,应用内膜下血管成形术治疗36条下肢动脉硬化闭塞的患肢,动脉闭塞的平均长度为11.5 cm(4.5～28.0 cm),其中13条...目的评价内膜下血管成形术(SIA)治疗下肢动脉硬化闭塞症的技术可行性和近期临床效果。方法从2003年12月至2005年12月2年期间,应用内膜下血管成形术治疗36条下肢动脉硬化闭塞的患肢,动脉闭塞的平均长度为11.5 cm(4.5～28.0 cm),其中13条肢体为生活方式受限性间歇性跛行,23条肢体为威胁肢体生存的严重性缺血。分析评价的主要参数为,内膜下血管成形术的技术成功率,再管化通道的通畅率,临床有效率和并发症。结果内膜下血管成形术的技术成功率为80%,技术失败的7条肢体有4条成功地进行了血管旁路手术。平均随访13.2个月,再管化通道的通畅率为70%,临床有效率为81%,尤严重的相关并发症发生。结论 SIA 是治疗下肢动脉粥样硬化闭塞一种较好的可供选择的治疗手段,技术成功率高,近期效果尚满意。但 SIA 术后长期效果目前尚缺乏可信服的临床资料。展开更多
目的探讨同期双向内膜下血管成形技术（subintimal arterial flossing with antegrade-retrograde intervention，SAFARI）治疗下肢动脉慢性全堵病变（chronic total occlusions，CTO）的技术要点和注意事项。方法2009年5月至2010年8月...目的探讨同期双向内膜下血管成形技术（subintimal arterial flossing with antegrade-retrograde intervention，SAFARI）治疗下肢动脉慢性全堵病变（chronic total occlusions，CTO）的技术要点和注意事项。方法2009年5月至2010年8月应用SAFARI技术对15例下肢动脉CTO病变患者进行了血管腔内治疗，其中男性8例，女性7例；年龄65～91岁，平均年龄74．9岁。按Rutherford下肢缺血分级标准：3级3例，4级6例，5级5例，6级1例。本组患者均为经传统内膜下血管成形术失败，进行了血管腔内动脉重建。结果全组手术技术成功率为14／15。踝肱指数由术前0．39提高至术后1周的0．83。随访2-14个月，平均随访时间5．9个月。1例于术后1个月内发生支架内血栓形成。症状缓解率13／15，溃疡愈合率14／15。结论SAFARI技术治疗下肢动脉CTO腔内治疗，成功率及保肢率高，并发症较少，值得临床广泛应用。展开更多
Objective: The present study was conceived to analyze the clinical benefit of hybrid interventions with surgical common femoral artery (CFA) reconstruction coupled to superficial femoral/popliteal endovascular recanal...Objective: The present study was conceived to analyze the clinical benefit of hybrid interventions with surgical common femoral artery (CFA) reconstruction coupled to superficial femoral/popliteal endovascular recanalization for severe infrainguinal multilevel occlusive disease in high-risk ASA Class 3 - 4 patients. Material and Methods: From August 2008 until May 2015, a series of 143 hybrid infrainguinal interventions in 124 ASA Class 3 - 4 patients were performed in our department for Rutherford category 2 - 6 ischemic presentations. Patient demographics, specific risk factors, technical characteristics and patency results were retrospectively examined during a mean 36.8 months of follow-up. In a majority of 94 limbs (65%), the endovascular stage of interventions focused on long (>15 cm) femoropopliteal occlusions in parallel to regular CFA surgical revascularization. Two or three runoff tibial trunks were evinced in 84% cases, while one or none permeable vessel was found in 23 (16%) limbs. Results: Inasmuch surgical approach was successful in all cases, the endovascular stage was technically profitable in 134 (93%) cases. The ABI posto-peratively improved (>1.5) in 73% of cases, while clinical presentation gained at least one Rutherford category in 89% limbs. The mean hospital stay was 6.1 days (3 - 12 days) whereas the 30-day mortality rate in this homogeneous “high-risk” group of patients was 3.2%. Global risk factors alike age (>70 years/p = 0.0005), smoking ((p = 0.0170) and female gender (p = 0.0111), together with CTOs length (>15 cm/(p = 0.0470), severe calcifications (p = 0.0001), poor tibial runoff (p = 0.0001), TASC “C” and “D” lesions (p = 0.360 and (p = 0.0394), the stent number ((n = 3) and length (>6 cm) ((p = 0.0039 and (p = 0.0003) and the initial ABI scoring ((p = 0.0051) showed statistical negative influence on primary patency. Conclusion: Hybrid infrainguinal revascularization may afford useful results in selected ASA “high risk” patients, owning low invasiveness, reproducib展开更多
文摘目的评价内膜下血管成形术(SIA)治疗下肢动脉硬化闭塞症的技术可行性和近期临床效果。方法从2003年12月至2005年12月2年期间,应用内膜下血管成形术治疗36条下肢动脉硬化闭塞的患肢,动脉闭塞的平均长度为11.5 cm(4.5～28.0 cm),其中13条肢体为生活方式受限性间歇性跛行,23条肢体为威胁肢体生存的严重性缺血。分析评价的主要参数为,内膜下血管成形术的技术成功率,再管化通道的通畅率,临床有效率和并发症。结果内膜下血管成形术的技术成功率为80%,技术失败的7条肢体有4条成功地进行了血管旁路手术。平均随访13.2个月,再管化通道的通畅率为70%,临床有效率为81%,尤严重的相关并发症发生。结论 SIA 是治疗下肢动脉粥样硬化闭塞一种较好的可供选择的治疗手段,技术成功率高,近期效果尚满意。但 SIA 术后长期效果目前尚缺乏可信服的临床资料。
文摘目的探讨同期双向内膜下血管成形技术（subintimal arterial flossing with antegrade-retrograde intervention，SAFARI）治疗下肢动脉慢性全堵病变（chronic total occlusions，CTO）的技术要点和注意事项。方法2009年5月至2010年8月应用SAFARI技术对15例下肢动脉CTO病变患者进行了血管腔内治疗，其中男性8例，女性7例；年龄65～91岁，平均年龄74．9岁。按Rutherford下肢缺血分级标准：3级3例，4级6例，5级5例，6级1例。本组患者均为经传统内膜下血管成形术失败，进行了血管腔内动脉重建。结果全组手术技术成功率为14／15。踝肱指数由术前0．39提高至术后1周的0．83。随访2-14个月，平均随访时间5．9个月。1例于术后1个月内发生支架内血栓形成。症状缓解率13／15，溃疡愈合率14／15。结论SAFARI技术治疗下肢动脉CTO腔内治疗，成功率及保肢率高，并发症较少，值得临床广泛应用。
文摘Objective: The present study was conceived to analyze the clinical benefit of hybrid interventions with surgical common femoral artery (CFA) reconstruction coupled to superficial femoral/popliteal endovascular recanalization for severe infrainguinal multilevel occlusive disease in high-risk ASA Class 3 - 4 patients. Material and Methods: From August 2008 until May 2015, a series of 143 hybrid infrainguinal interventions in 124 ASA Class 3 - 4 patients were performed in our department for Rutherford category 2 - 6 ischemic presentations. Patient demographics, specific risk factors, technical characteristics and patency results were retrospectively examined during a mean 36.8 months of follow-up. In a majority of 94 limbs (65%), the endovascular stage of interventions focused on long (>15 cm) femoropopliteal occlusions in parallel to regular CFA surgical revascularization. Two or three runoff tibial trunks were evinced in 84% cases, while one or none permeable vessel was found in 23 (16%) limbs. Results: Inasmuch surgical approach was successful in all cases, the endovascular stage was technically profitable in 134 (93%) cases. The ABI posto-peratively improved (>1.5) in 73% of cases, while clinical presentation gained at least one Rutherford category in 89% limbs. The mean hospital stay was 6.1 days (3 - 12 days) whereas the 30-day mortality rate in this homogeneous “high-risk” group of patients was 3.2%. Global risk factors alike age (>70 years/p = 0.0005), smoking ((p = 0.0170) and female gender (p = 0.0111), together with CTOs length (>15 cm/(p = 0.0470), severe calcifications (p = 0.0001), poor tibial runoff (p = 0.0001), TASC “C” and “D” lesions (p = 0.360 and (p = 0.0394), the stent number ((n = 3) and length (>6 cm) ((p = 0.0039 and (p = 0.0003) and the initial ABI scoring ((p = 0.0051) showed statistical negative influence on primary patency. Conclusion: Hybrid infrainguinal revascularization may afford useful results in selected ASA “high risk” patients, owning low invasiveness, reproducib
