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1、长段股浅动脉闭塞腔内治疗,王峰 纪东华 大连医科大学附属第一医院介入科,前 言,TASC 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 lesions-Chronic total occlusions of CFA or SFA(20 cm,
2、involving the popliteal artery)-Chronic total occlusion of popliteal artery and proximal trifurcation vessels,“Bypass better than Endovascular”,Charing Cross 33,New TASC guidelines are set to recommend an endovascular first strategy even for TASC D lesions.Johannes Lammer,Vienna,Austria,told CX 33 d
3、elegates that an“endovascular first”strategy for all TASC lesions was recommended in the proposed update to the TASC II guidelines.,大连医科大学附属一院,2008年1月-2010年2月143例失访：30例死亡：5例二次手术：39例截肢：6例,腔内治疗的2年保肢率：94.2%；一期通畅率：59.8%。,期待更多中心联合的结果！,TASC C&D Lesions for SFA,腔内治疗的方法内膜下成型术：a.顺行 b.逆行 c.顺+逆行器械辅助内膜下成型术：a.导丝
4、穿刺 b.球囊辅助 c.Outback导管器械辅助开通：Frontrunner内膜旋切术,SIA-经对侧或同侧股动脉顺行,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导管跟入腹主动脉,术后ABI:0.81,球囊辅助的SIA,ABI：左 0.5 右 0,Admiral 6/60mm,腘动脉逆行穿刺,球囊顺行撕开内膜,Admiral 4/120m
5、m,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,Recross 18 2/80 V18,Recross 2/80,Batam 2.5/80,Everflex 6/200,Frontrunner 辅助,右下肢跛行200米，ABI：0.3,ABI:1.0,Outback导管辅助的SIA,Silverhawk 处理支架长段闭塞,SFA的腔内治疗现状,冷冻球囊：Karthik 等认为冷冻球囊对再狭窄病例的通畅率没有显著改善。Karthik S,Tuite DJ,Nicholson AA,et al.Cryoplasty for
6、arterial restenosis.Eur J Vasc Endovasc Surg.2007;33:4043.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。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.,内膜旋切：TALON研究显示：内膜旋切配合药物治
7、疗可能会降低再狭窄的发生率。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.激光消融：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。Scheinert D,Laird JR,Schroder M,et al.Excimer laser-assisted recanalizat
8、ion of long,chronic superficial femoral artery occlusions.J Endovasc Ther.2001;8:156166.,药物涂层支架：SIROCCO II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。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 Interv Radiol.2005;16:331338.,“腔内治疗操作成功率超过82%,而肢体挽救成功率甚至高达98%,临床效果可媲美甚至超过外科搭桥手术。”我们努力要把腔内治疗做得更好！,谢谢！,
