CTO腔內(nèi)完整版資料

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1、單擊此處編輯母版標題樣式,單擊此處編輯母版文本樣式,第二級,第三級,第四級,第五級,*,單擊此處編輯母版標題樣式,單擊此處編輯母版文本樣式,第二級,第三級,第四級,第五級,*,CTO-Background,Definition,C,hronic,T,otal,O,cclusion,Prevalence,PAD(non-invasive test),40-59 years of age:2.5%,60-69 years of age:8.3%,70-79 years of age:18.8%,Vasc Med 1997;2:221-226,腔內(nèi)治療技術,血管穿刺技術,導管、導絲的選擇,造影劑的應

2、用,血管造影技術,經(jīng)皮腔內(nèi)血管擴張成形,血管內(nèi)支架植入,穿刺技術,1953,年，,Seldinger,經(jīng)皮穿股動脈，用導絲引導導管插入的血管造影技術,Cross-Over Approach,Transbrachial Approach for SFA-Reca.?,6F-90cm-sheath,160cm-shaft balloons(e.g.Invatec),150cm-shaft stents(e.g.Optimed),Poor steerability of guidwires,Poor trackability of balloons/stents,如順血流方向?qū)Ч懿荒芑厝牍蓜?1 年

3、一期通暢率:50%,Recanalization-techniques,Transbrachial Approach for SFA-Reca.,必要時膝上腘動脈內(nèi)可置入4F鞘,Poor steerability of guidwires,60-69 years of age:8.,適應癥 順血流方向腔內(nèi)成形術失敗,Nitinol-stents,球囊導管（deep,Rekross18）,Nitinol-stents,順血流方向?qū)嵤㏄TA&stents,ultrasound directed popliteal artery puncture,Puncture with duplex-sonog

4、raphic or,60-69 years of age:8.,sheathless trans-popliteal artery approach,Figure 4,Transpopliteal ApproachFor SFA-Recanalization,Only if antegrade approach fails,Puncture with duplex-sonographic or,angiographic guidance,4-6 Fr.10cm sheath,Puncture-level not too low,SFA-Recanalization Techniques,Rec

5、analization-techniques,Subintimal vs.,intraluminal,Primary/provisional,Nitinol-stents,Bioabsorbable stents,Drug-eluting balloon,Drug-eluting stents,Covered stents,CTO,的特殊技術,內(nèi)膜下成形技術,技術成功率,:80%-90%,成功率,小腿病變,SFA,1,年臨床成功率,:50%-70%,1,年一期通暢率,:50%,1,年肢體保肢率,:80%-90%,并發(fā)癥,:8%-17%,多數(shù)為小的并發(fā)癥,Cardiovasc Interv Ra

6、diol 2008;31:687-697,Cross-Over for SFA-,Recanalization,Case presentation,SFA-SIA,SFA-SIA,SFA-SIA,SFA-SIA,CTO,的特殊技術,-,(S,AFARI),Subintimal Arterial Flossing WithAntegradeRetrograde Intervention,如順血流方向?qū)Ч懿荒芑厝牍蓜?脈遠端真腔 遠端流出道穿刺,逆血流方向?qū)Ыz進入與順血流方,向?qū)Ч芟嗤墓芮婚g隙,順血流方向?qū)嵤?PTA&stents,“SAFARI-Technique”,腘動脈或膝下動脈穿刺,適應

7、癥,順血流方向腔內(nèi)成形術失敗,腘動脈及小腿動脈有至少,1,根以上,的流出道,方 法,路徑圖下或超聲引導下,器 械,微穿刺針（,COOK,）,0.018,導絲（,V18,）,球囊導管（,deep,Rekross18,）,必要時膝上腘動脈內(nèi)可置入,4F,鞘,Through-Through,技術,脛前動脈穿刺,-,入脛腓干,腘動脈左斜,25,度穿刺,ultrasound directed popliteal artery puncture,sheathless trans-popliteal artery approach,V-18control guidewire,Submarine 3/60,腘

8、動脈穿刺,器 械 微穿刺針（COOK）,脈遠端真腔 遠端流出道穿刺,Puncture with duplex-sonographic or,Subintimal vs.,技術成功率:80%-90%,Puncture-level not too low,V-18control guidewire,Nitinol-stents,6F-90cm-sheath,逆血流方向?qū)Ыz進入與順血流方,脛前動脈穿刺-入脛腓干,“SAFARI-Technique”,Case presentation SFA-SIA,Vasc Med 1997;2:221-226,如順血流方向?qū)Ч懿荒芑厝牍蓜?Puncture-site of transpedal recanalization,腔內(nèi)治療并發(fā)癥,治療過程中,血管破裂,導管、導絲及支架斷裂,造影劑過敏,治療后,血腫,動脈假性動脈瘤,動、靜脈瘺,神經(jīng)損傷,造影劑腦病、腎病,處理,凝血酶時間的糾正,B,超引導下凝血酶注射,手術修復,腘動脈支架置入,現(xiàn)實中我們的對手,我們擁有：技術、責任感、團隊,謝謝,