血管功能区指导下对的动脉腔内治疗.ppt

根据溃疡区域进行治疗方案分类 DR （Direct revascularization) IR ( Indirect revascularization) IRc (IR ‘‘through collaterals’’) BTK/BTA CTO病变腔内治疗 合理评估闭塞性质 真腔/内膜下技术 经小腿动脉逆向穿刺技术 血管功能区指导下的动脉腔内治疗(Angiosome 概念) 腔内治疗常用设备 亲水导丝 - 0.035 stiff trumo - 0.018” V-18 control - 0.014” pt 2 小管径球囊(膝下） - submarine - Deep - Savvy long - sleek - Reekross 病例1 拟治疗靶血管： 右股腘动脉 右胫前动脉 病例1 病例 2 治疗计划1.支架内球囊扩张 2. 胫后动脉重建术后结果 症状缓解； ABI 0.94  随访：术后1月溃疡缩小近1/2 病例3 男，93 ys. 左下肢 静息痛 足趾破溃4M 脑梗史 ABI：L 0.26 R 0.6 腔内治疗步骤 1. 对侧股动脉穿刺 2. 股深动脉血管腔内重建 (图1) 3. 经内膜下sFa 重建( subintimal technique stifftrumo 0.035”, V- 18 0.018”; Sailor PTA 5/120) 4.腘动脉入真腔 (图2) 5. 顺行膝下腘及胫腓干重建 4F MPA 导管; V-18 0.018”(图3) 男性，74岁 左足静息痛伴破溃2月 诊断：左下肢ASO DM Rutheford 5 ABI 0.21 BTK-CTO 技术 Devices BTK arteries diameter 1.5 – 3mm (75% stenoses: 0.37 – 0.75mm) guide wires 0.035“ = 0.89mm 0.014“ = 0.36mm ballons 5F = 1.67mm 3F = 1.00mm my preferences: 0.014“ PT 2 导丝 BTK-CTO 技术 BTK-CTO: intraluminal – subintimal many diabetes patients peripheral lesion location (narrow lumen) heavy intimal calcifications distal re-entry difficult my preference intraluminal BTK-CTO 技术 How to cross CTO BTK? 需要使用不同的导管,导丝,球囊等 需要坚持,需要耐心和恒心 需要运气和临床介入操作经验 ...... 谢 谢！ Thanks The angiosome concept for healing pedal lesions in patients with critical limb ischemia (CLI) was initially described by Taylor and Pan in 1998[1], separating the leg into a three-dimensional territory of tissue divided into six sections supplied by the three tibial vessels. Understanding the angiosomes of the foot and ankle and their source arteries is paramount when one considers revascularizing and taking care of the wounds in the patient with CLI. Simply put: pulsatile flow to the correct portion of the foot is paramount for ulcer healing, a