膝下血管腔內(nèi)治療策略教程教案

膝下血管腔內(nèi)治療策略莊百溪現(xiàn)狀患病率升高

老齡化年代、糖尿病人、不良生活習慣導致動脈硬化發(fā)生率增高發(fā)病率升高

檢查手段改善，更多的發(fā)現(xiàn)膝下病變就診多為晚期患者知曉率低，醫(yī)師敏感度差閉塞動脈開通率低多為多支長段嚴重鈣化的閉塞經(jīng)濟負擔重（放置支架的可能性增大）、忍受痛苦（截肢、截趾發(fā)生率高）現(xiàn)有治療策略通常對間歇性跛行患者不實施膝下腔內(nèi)治療UseofthistechniqueisusuallynotindicatedinpatientswithintermittentclaudicationTASCIIF3.2Endovasculartreatmentofinfrapoplitealocclusivedisease對嗎？由于膝下血管管徑較小，一旦發(fā)展為完全閉塞，再次開通的機會將大大降低，給臨床工作帶來極大的困難短段病變?nèi)鐩]有被積極治療，會逐漸在遠近端形成血栓，進而機化，進展為長段完全閉塞，給治療帶來更多困難所以，我們應該提倡及早治療血管病變從手術角度也要求及早治療膝下血管病變常見膝下病變類型穿刺點選擇盡可能采用同側順行穿刺，可獲得更佳的導絲操控性伴有髂股動脈病變的患者，可采用對側穿刺，方便同期治療髂、股腘動脈病變術中治療策略三支血管各有作用，當某一支血管病變時，相應供血區(qū)域會出現(xiàn)癥狀尤其伴有糖尿病患者，側枝循環(huán)較差，更易出現(xiàn)僅單支血管病變就導致CLI的現(xiàn)象術中盡可能開通全部病變血管，建立直達足部血流（in-lineflowtothefoot）DPATDPAT膝下支架術前擴張后支架后膝下支架膝下支架術前球擴后支架后強調(diào)足底、足背動脈弓的重要意義總結腔內(nèi)治療膝下血管病變應早期診斷，早期治療術中盡可能開通全部病變血管，建立直達足部血流（in-lineflowtothefoot）重視足底動脈弓及足背動脈弓多學科合作，注重預防和治療Thetibials:EndovascularTreatmentStrategiesBAIXIZHUANGTheStatusHighMorbidityrateaging、diabetic、foodanddrinkhadmademorearteriosclerosisHighMorbilityrate

advancedmethodcanfindmoreBTKlesionMostpatientswereCLIpoorawarenes，doctorpaylessattentionHardtoopenocclusion

multi-branch,longsegment,severecacificationChargewillhigher（Possibilityofstentishigher）、sufferpain（higheramputationrate）StrategiesaboutEndovasculartreatmentofinfrapoplitealocclusivediseaseinTASCIIAngioplastyofashortanteriororposteriortibialarterystenosismaybeperformedinconjunctionwithpoplitealorfemoralangioplasty.Useofthistechniqueisusuallynotindicatedinpatientswithintermittentclaudication.

TASCIIF3.2EndovasculartreatmentofinfrapoplitealocclusivediseaseWhenisthebesttime？Strategiesaboutcoronaryarterydisease：myocardialinfarct？anginapectoris！Thesametoleg！stenosis、singlelesionshouldbetreatedintime,especiallyfordiabeticTreatfootliketreatheart！CommonBTKlesion

WheretopunctureAntegradepunctureasposibleasyoucan，youcancontrolthewiremoreeasyStrategieswhenoperationEachbranchhasitsrole.LesioninonebranchmayinduceCLIincorrespondingsupplyarea,especiallyinpeoplewithdiabetesforthelackofcollateralcirculationWeshouldmadein-lineflowtothefoot!DPATDPATBTKstent術前擴張后支架后BTKstentBTKstent術前球擴后支架后importantStatusofpedalandplantararchveryimportantSummaryTheearlierthebetterWeshouldmadein-linefl