《周围动脉疾病》.ppt

编辑课件 治疗篇－肾动脉介入治疗 治疗篇－颈动脉支架植入术 治疗篇－腹主动脉狭窄介入治疗 * 周围动脉疾病(peripheral artery disease，PAD) 有症状的动脉硬化对上肢和手的血供影响较下肢少。 非侵袭性检查手段显示无症状的PAD发病率比有症状者高3倍。 * The major cause of occlusive PAD is arteriosclerosis obliterans, defined as the development of atherosclerotic plaques in the peripheral vasculature. These plaques develop as a result of endothelial activation associated with conditions such as dyslipidemia, diabetes mellitus, hypertension, etc. Plaques resulted din the proliferation of vascular smooth muscle, with subsequent damage to the vascular structure. The lesion themselves can be unstable and rupture, or adjacent smaller vessels experiencing high hemodynamic pressure caused by nearby plaque may rupture. Arterial stenosis impedes blood flow creating ischemia which later decreases normal function of the affected area. Atherosclerotic plaque obstructing 70% or less of a lumen is unlikely to produce ischemic pain at rest, but when the artery is challenged by the increased oxygen demands of exertion, painful leg cramping (intermittent claudication) may occur. Occlusion of the lumen of 90% or more will likely produce pain at rest and even greater pain on exertion. * Although claudication symptoms are typically localized in the calf or the thigh, “rest pain” is characteristically in the foot. In patients with claudication, the severity of the condition increases slowly; 25% have worsening claudication, and 5% undergo an amputation within 5 years. Less than 5 to 10% of patients have critical leg ischemia (ischemic pain in the distal foot, ischemic ulceration, or gangrene), but their risk of limb loss is substantial. Clinical Examination through skin color. Ask the patient to raise his two legs against the wall. The color of the an ischemic legs will turn pale upon raising and the temperature is cold. Let the patient put the two legs down afterwards. The color of the normal leg will turn red immediately however, the ischemic leg, the redness is not that intensified as co