2019开放手术联合腔内治疗严重下肢缺血疾病化学.ppt

开放手术联合腔内治疗开放手术联合腔内治疗开放手术联合腔内治疗开放手术联合腔内治疗严重下肢缺血性疾病严重下肢缺血性疾病严重下肢缺血性疾病严重下肢缺血性疾病天津市人民医院天津市人民医院栗力栗力下肢动脉缺血腔内治疗下肢动脉缺血腔内治疗 天津医科大学附属人民医院天津医科大学附属人民医院血管科血管科 栗栗 力力 2007年年2月至月至2008年年5月天月天津市人民医院血管外科收治津市人民医院血管外科收治下肢动脉缺血患者共下肢动脉缺血患者共150例，例，介绍部分接受外科手术和腔介绍部分接受外科手术和腔内血管成形术的典型病例。内血管成形术的典型病例。1 1、短段下肢动脉、短段下肢动脉狭窄及闭塞病变狭窄及闭塞病变 2 2、长段动脉闭塞病变、长段动脉闭塞病变术中术后术前术后6天3 3、股动脉、腘动、股动脉、腘动脉完全闭塞脉完全闭塞 股动脉内膜剥脱股动脉内膜剥脱术前术后20小时4 4、双髂动脉及左、双髂动脉及左股浅动脉闭塞股浅动脉闭塞 左髂动脉未能探通，右髂总动脉支架置入术，同期行股-股、股-腘动脉人工血管旁路术。截趾术后愈合良好截趾术后愈合良好 截趾术后愈合良好 术后5个月出现左下肢发凉、麻木及疼痛，CTA提示人工血管内血栓形成。行人工血管切开取栓及腔内治疗。取栓后造影显示远端吻合口狭窄5 5、人工血管旁路术、人工血管旁路术后急性血栓形成后急性血栓形成 双股-腘动脉人工血管旁路术、左侧输出道动脉段内膜剥脱术。术后20小时出现左下肢发凉、远端动脉搏动消失，DSA检查，证实血栓形成，急症行人工血管切开取栓及血管成形支架置入术。取栓后腔内治疗取栓后腔内治疗讨论讨论1、延时造影无输出道股腘动脉长段闭塞应如何处理？2、输出道多段病变的股腘旁路术，围手术期移植物急性血栓形成的处理？3、同期贯序旁路术后移植物闭塞的好发部位？Endovascular treatment Endovascular treatment for ischemic disease in for ischemic disease in lower limblower limb天津市人民医院天津市人民医院栗力栗力Endovascular treatment for ischemic disease in lower limbLi Li Vascular department Union medical centre,Tianjin There are 150 cases treated in vascular department in Union medical center Tianjin from Feb.2007 to May 2008,I ll showcase some typical cases treated with open and interventional angioplasty.1 1、Short segment arterial stenosis and occlusion in Lower extremity 2 2、Long segment Long segment arterial blockagearterial blockagepostoperationpreoperation6 days later 3 3、Entire Entire occlusion in SFA occlusion in SFA and popliteal and popliteal arteryartery Endarterectomy in SFApreoperation20 hours later4 4、Bilateral Bilateral iliac and LSFA iliac and LSFA occlusionocclusion failed in left iliac arterial failed in left iliac arterial vascularization,stenting was vascularization,stenting was performed in right common iliac,performed in right common iliac,femoral-femoral bypass and femoral-femoral bypass and femoral-popliteal artificial graft femoral-popliteal artificial graft bypass were performed bypass were performed simutaneously.simutaneously.Good result after the amputation 截趾术后愈合良好 Presented with Presented with cold and numb in cold and numb in left leg five left leg five months later after months later after the operation,the operation,Thrombosis was Thrombosis was confirmed in graft confirmed in graft by CTA.Graft by CTA.Graft thrombectomy thrombectomy and endovascular and endovascular treatment was treatment was performed.performed.Stenosis was shown by angiogram at distal anastomosic site after the thrombectomy.5 5、Acute Acute thrombosis in thrombosis in graft after graft after operation.operation.Bilateral SFA-PA bypass,endarterectomy was performed in left outflow artery.Cold and pulseless were presented left leg.Thrombosis was confirmed in graft by DSA.Thrombectomy and stenting was performed urgently.Endovascular treatment was performed after thrombectomyDiscussion1、How to treat the long segment occlusivedisease without outflow in angiogram?2、Treatment of acute thrombosis in SFA-PA bypass with multiple disease in outflow?3、Where is the region usually blocked after sequent graft bypass?