Substent在下肢ASO治疗中的应用.pptxVIP

Substent在下肢ASO治疗中的应用;患者，女，85岁 因“双下肢间跛2年，左下肢静息痛伴足趾溃疡1月”入院 查体：双下肢等粗等长，无肿胀，腓肠肌松软。双侧股动脉搏动明显，左腘动脉未扪及，足背及胫后动脉未扪及，左足皮温降低，色暗红，第一、二趾破溃伴坏疽。 术前ABI：左0.48，右0.65 患者2年前曾行双下肢动脉PTA+stent术 ;术前CTA;;;;;;;;;术后第7天，患者再次出现左下肢发凉 经右股动脉穿刺插管行左下肢动脉DSA检查＋左下肢动脉狭窄段球囊扩张+支架植入术 主要材料 Invatec球囊导管 4.0mm*120mm Cordis P3球囊导管5.0mm*200mm Cordis S.M.A.R.T 支架 6.0mm*100mm ;;;讨 论;per-interventional extraluminal recanalization (PIER);If a patient presents with claudication symptoms caused by in-stent restenosis or occlusion, one can try to recanalize the occluded stent. This is often not possible, especially if the occlusion is of an older date and consists of fibrosed tissue, mainly because of reorganizing thrombus. Subintimal passage of a occluded stent using the PIER technique could be an option in such cases.;Subintimal Recanalization of Occluded Stents: The Substent Technique;Substent Technique;4F angled-tip hydrophilic catheter (Terumo, Japan) 0.035-inch hydrophilic standard angled tip guide wire (Terumo, Japan) or the half-stiff 0.035-inch J-tip glide wire (Terumo, Japan) Subintimal/substent space bypass the previously stented Distal vessel lumen reentry may be accomplished with the loop technique or with modern image-guided reentry devices if necessary. Reentry was always attempted at a healthy proximal segment of the treated vessel with respect to large collateral arteries. High-pressure balloon angioplasty (up to 24 atm) of the subintimal/substent space was performed to push the previously occluded stent laterally and create a new lumen. Predilatation with a low-profile angioplasty balloon may apply in order to allow crossing of the high-pressure balloon catheter. During substent angioplasty, occluded balloon-expandable stents may be severely deformed and crushed, whereas self-expanding stents may be temporarily compressed. Additionally, in the vast majority of the cases, a self-expanding stent with an oversized diameter and adequate radial force had to be inserted to avoid early ela