長段股淺動(dòng)脈閉塞腔內(nèi)治療

1、長段股淺動(dòng)脈閉塞腔內(nèi)治療長段股淺動(dòng)脈閉塞腔內(nèi)治療王峰王峰 紀(jì)東華紀(jì)東華 大連醫(yī)科大學(xué)附屬第一醫(yī)院介入科大連醫(yī)科大學(xué)附屬第一醫(yī)院介入科1st Hosp of D.M.U前前 言言vTASC II -2007Type 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

2、 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”1st Hosp of D.M.UCharing Cross 33vNew TASC guidelines are set to recommend an endovascular first s

3、trategy even for TASC D lesions.vJohannes 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. 1st Hosp of D.M.U大連醫(yī)科大學(xué)附屬一院大連醫(yī)科大學(xué)附屬一院2008年年1月月-2010年年2月月v143例例v失訪：失訪：30例例v死亡：死亡：5例例v二次手

4、術(shù)：二次手術(shù)：39例例v截肢：截肢：6例例腔內(nèi)治療的腔內(nèi)治療的2年保肢率：年保肢率：94.2%；一期通暢率：；一期通暢率：59.8%。期待更多中期待更多中心聯(lián)合的結(jié)心聯(lián)合的結(jié)果！果！1st Hosp of D.M.UTASC C&D Lesions for SFAv 腔內(nèi)治療的方法腔內(nèi)治療的方法v 內(nèi)膜下成型術(shù)：內(nèi)膜下成型術(shù)：a.順行順行 b.逆行逆行 c.順順+逆行逆行v 器械輔助內(nèi)膜下成型術(shù)：器械輔助內(nèi)膜下成型術(shù)：a.導(dǎo)絲穿刺導(dǎo)絲穿刺 v b.球囊輔助球囊輔助 c. Outback導(dǎo)管導(dǎo)管v 器械輔助開通：器械輔助開通：Frontrunner1. 內(nèi)膜旋切術(shù)內(nèi)膜旋切術(shù)1st Hos

5、p of D.M.USIA-經(jīng)對(duì)側(cè)或同側(cè)股動(dòng)脈順行經(jīng)對(duì)側(cè)或同側(cè)股動(dòng)脈順行1st Hosp of D.M.U1st Hosp of D.M.USIA-經(jīng)腘動(dòng)脈逆行經(jīng)腘動(dòng)脈逆行1st Hosp of D.M.U1st Hosp of D.M.U1st Hosp of D.M.USIA-經(jīng)患側(cè)腘動(dòng)脈及健側(cè)股動(dòng)脈順行經(jīng)患側(cè)腘動(dòng)脈及健側(cè)股動(dòng)脈順行-逆行逆行1st Hosp of D.M.U1st Hosp of D.M.U1st Hosp of D.M.USIA-經(jīng)肱、腘動(dòng)脈順行經(jīng)肱、腘動(dòng)脈順行-逆行逆行1st Hosp of D.M.U1st Hosp of D.M.U1st Hosp of D.M.

6、U1st Hosp of D.M.U導(dǎo)絲穿刺輔助的導(dǎo)絲穿刺輔助的SIAv 右下肢靜息痛，右下肢靜息痛，ABI: 0.10既往既往3月前在外院行髂動(dòng)脈支架成型術(shù)，現(xiàn)發(fā)現(xiàn)支架遠(yuǎn)端在月前在外院行髂動(dòng)脈支架成型術(shù)，現(xiàn)發(fā)現(xiàn)支架遠(yuǎn)端在IIA。1st Hosp of D.M.U經(jīng)腘動(dòng)脈逆行無法返回經(jīng)腘動(dòng)脈逆行無法返回1st Hosp of D.M.U一周后一周后以sv5導(dǎo)絲硬頭髂總動(dòng)脈穿刺回真腔，再以導(dǎo)絲硬頭髂總動(dòng)脈穿刺回真腔，再以progreat導(dǎo)管跟入腹主動(dòng)脈導(dǎo)管跟入腹主動(dòng)脈1st Hosp of D.M.U術(shù)后術(shù)后ABI:0.811st Hosp of D.M.U球囊輔助的球囊輔助的SIAABI：左：

7、左 0.5 右右 01st Hosp of D.M.UAdmiral 6/60mm1st Hosp of D.M.U1st Hosp of D.M.U腘動(dòng)脈逆行穿刺腘動(dòng)脈逆行穿刺,球囊順行撕開內(nèi)膜球囊順行撕開內(nèi)膜Admiral 4/120mm1st Hosp of D.M.U導(dǎo)絲順行進(jìn)入逆行的導(dǎo)管導(dǎo)絲順行進(jìn)入逆行的導(dǎo)管1st Hosp of D.M.U1st Hosp of D.M.U術(shù)后造影結(jié)果術(shù)后造影結(jié)果1st Hosp of D.M.U雙球囊輔助導(dǎo)絲穿刺的雙球囊輔助導(dǎo)絲穿刺的SIA右足右足2、3趾破潰，靜息痛；趾破潰，靜息痛；ABI:01st Hosp of D.M.U順行開通困難順行開

8、通困難1st Hosp of D.M.URecross 18 2/80 V181st Hosp of D.M.URecross 2/80Batam 2.5/801st Hosp of D.M.UEverflex 6/2001st Hosp of D.M.U1st Hosp of D.M.UFrontrunner 輔助輔助右下肢跛行右下肢跛行200米，米，ABI：0.31st Hosp of D.M.U1st Hosp of D.M.U1st Hosp of D.M.UABI:1.01st Hosp of D.M.UOutback導(dǎo)管輔助的導(dǎo)管輔助的SIA1st Hosp of D.M.U1st

9、 Hosp of D.M.U1st Hosp of D.M.USilverhawk 處理支架長段閉塞處理支架長段閉塞1st Hosp of D.M.U1st Hosp of D.M.U1st Hosp of D.M.USFA的腔內(nèi)治療現(xiàn)狀的腔內(nèi)治療現(xiàn)狀v冷凍球囊：冷凍球囊： Karthik 等認(rèn)為冷凍球囊對(duì)再等認(rèn)為冷凍球囊對(duì)再狹窄病例的通暢率狹窄病例的通暢率沒有顯著改善沒有顯著改善。 Karthik S, Tuite DJ, Nicholson AA, et al.Cryoplasty for arterial restenosis. Eur J Vasc Endovasc Surg. 200

10、7;33:4043.v切割球囊：切割球囊：Mauri等認(rèn)為切割球囊比較普通球囊等認(rèn)為切割球囊比較普通球囊而言并沒有顯著降低再狹窄的療效。而言并沒有顯著降低再狹窄的療效。 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;90:10791083.1st Hosp of D.M.Uv內(nèi)膜旋切：內(nèi)膜旋切：TAL

11、ON研究顯示：內(nèi)膜旋切配研究顯示：內(nèi)膜旋切配合藥物治療可能會(huì)降低再狹窄的發(fā)生率。合藥物治療可能會(huì)降低再狹窄的發(fā)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.v激光消融：激光消融：Scheinert等報(bào)道：激光消融的等報(bào)道：激光消融的SFA的的一年通常率是一年通常率是33.6%，所以在處理再狹窄上無優(yōu)，

12、所以在處理再狹窄上無優(yōu)勢。勢。 Scheinert D, Laird JR, Schroder M, et al.Excimer laser-assisted recanalization of long,chronic superficial femoral artery occlusions.J Endovasc Ther. 2001;8:156166.1st Hosp of D.M.Uv藥物涂層支架：藥物涂層支架： SIROCCO II研究顯示其研究顯示其半年的再狹窄率為半年的再狹窄率為0%，對(duì)比裸支架，對(duì)比裸支架7.7%?？赡軙?huì)是降低再狹窄的一個(gè)好選擇?？赡軙?huì)是降低再狹窄的一個(gè)好選擇。 Duda SH, Bosiers M, Lammer J, et al. Sirolimus-eluting versus bare nitinol stent for obstructive superficial femoral artery disease: the SIROCCO II trial. J Vasc