长段股浅动脉闭塞腔内治疗.ppt
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 1st Hosp of D.M.U 前 言 vTASC II -2007 Type 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, involving the popliteal artery) - Chronic total occlusion of popliteal artery and proximal trifurcation vessels “Bypass better than Endovascular” 1st Hosp of D.M.U Charing Cross 33 vNew TASC guidelines are set to recommend an endovascular first strategy 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 大连连医科大学附属一院 2008年1月-2010年2月 v143例 v失访：30例 v死亡：5例 v二次手术：39例 v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！ 1st Hosp of D.M.U TASC C33:4043. v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;90:1079 1083. 1st Hosp of D.M.U v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 。 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：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 recanalization of long,chronic superficial femoral artery occlusions.J Endovasc Ther. 2001;8:156166. 1st Hosp of D.M.U v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. 1st Hosp of D.M.U “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 ！ 1st Hosp of D.M.U
