本文關(guān)鍵詞： 下肢動(dòng)脈缺血性病變 Viabahn覆膜支架 腔內(nèi)治療　出處：《大連醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：評(píng)估Viabahn覆膜支架在下肢動(dòng)脈缺血性病變的腔內(nèi)治療的短期療效。 方法：回顧性分析了從2013年4月到2013年11月我們所治療的下肢動(dòng)脈硬化閉塞癥患者17例（總共治療了17條患肢），其中男性13例（76.5%），女性4例（23.5%）。平均年齡68.8±8.1歲(54-81歲)，缺血程度按Rutherford分級(jí)：2級(jí)2例（11.8%），3級(jí)5例（29.4%），4級(jí)5例（29.4%），5級(jí)5例（29.4%）。膝下流出道情況：0條膝下流出道5例（29.4%），1條膝下流出道2例（11.8%），2條膝下流出道4例（23.5%），3條膝下流出道6例（35.3%）。并存病情況：合并高血壓的患者為11例（64.7%），合并糖尿病的為8例（47.1%），合并高血脂的為8例（47.1%），合并冠心病的為10例（58.8%）。病變按照血管的節(jié)段分：髂動(dòng)脈的病變，2例（11.8%），股乆動(dòng)脈的病變，11例（64.7%）,髂動(dòng)脈合并股乆動(dòng)脈的病變，4例（23.5%）,其中6例為裸支架植入術(shù)后再狹窄或閉塞（35.3%）。術(shù)前17條患肢平均ABI（Ankle/Brachial Index，踝肱指數(shù)）0.42±0.23。所有患者均在術(shù)前行下肢CTA和（或）動(dòng)脈彩色多普勒超聲明確下肢病變血管情況并測(cè)量病變的直徑。大部分病例病變血管都采用.VASIR（Viabahn-Assisted Subintimal Recanalization，Viabahn輔助下的內(nèi)膜下成形）技術(shù)。術(shù)后測(cè)定患肢的ABI，隨訪1月、3月、6月行動(dòng)脈彩色多普勒超聲或CTA評(píng)估通暢率，通過Rutherford分級(jí)的改善情況以及保肢率來評(píng)價(jià)療效。 結(jié)果：17條患肢手術(shù)的成功率達(dá)100%（17/17）。術(shù)后患者的平均ABI為：0.76±0.21，較術(shù)前患者的平均ABI明顯升高（P＜0.05㖞�；颊咝g(shù)后1個(gè)月，保肢率為100%（17/17）,3個(gè)月，，保肢率為100%（17/17）,6個(gè)月，保肢率為100%（17/17）。介入術(shù)后1個(gè)月，一期通暢率為100%（17/17）,3個(gè)月，一期通暢率為94.1%（16/17），二期通暢率為94.1%（16/17）,6個(gè)月，一期通暢率為70.6%（12/17），二期通暢率為88.2%（15/17）。 結(jié)論：1.利用Viabahn覆膜支架治療下肢動(dòng)脈硬化閉塞癥，手術(shù)的成功率高，有較高的保肢率及相對(duì)較高的通暢率。2.選擇合適的Viabahn支架直徑，保證較好的膝下流出道能夠提高通暢率及保肢率。
[Abstract]:Objective: to evaluate the short-term efficacy of Viabahn-covered stent in the intracavitary treatment of arterial ischemic lesions of the lower extremities. Methods: from April 2013 to November 2013, 17 patients with arteriosclerotic obliteration of lower extremity were retrospectively analyzed. Among them, 13 cases were male and 4 cases were female. The average age was 68.8 鹵8.1 years old and 54-81 years old. According to the Rutherford grade, 2 cases of grade 2 with 11.8 grade and 5 cases of grade 3 with grade 29.4 were found to have 5 cases of grade 29.44 and 5 cases of grade 5 of grade 29.44.The subgenu outflow tract was found in 5 cases with subgenu outflow tract in 5 cases with subgenicular outflow tract in 2 cases with subgenu outflow tract in 2 cases with 11.88% subknee outflow tract in 2 cases with subgenicular outflow tract in 4 cases and with 3 subknee outflow tract in 6 cases with 3 subknee outflow tract. There were 11 patients with hypertension, 8 with diabetes, 8 with hyperlipidemia, 10 with coronary heart disease, and 10 with coronary heart disease. The lesions were divided according to the segments of the blood vessels: iliac artery lesions in 2 cases, iliac artery lesions in 2 cases, and iliac artery lesions in 2 cases. Arterial lesions were found in 11 cases (64.7%), iliac artery combined with femoral lesions in 4 cases (23. 5%), among which 6 cases were restenosis or occlusion after bare stent implantation. Preoperative mean ABI(Ankle/Brachial index of 17 affected limbs and ankle brachial index (mBI) were 0. 42 鹵0. 23. All patients were treated with lower limb CTA before operation. (or) arterial color Doppler ultrasound was used to determine the vascular status and diameter of lower extremity lesions. Most of the diseased vessels were treated with subintimal angioplasty assisted by Viabahn-Assisted Subintimal. The ABI of affected limbs was measured after operation and followed up 1. The patency rate was evaluated by arterial color Doppler ultrasound or CTA on March and June. The efficacy was evaluated by the improvement of Rutherford classification and limb salvage rate. Results the successful rate of operation on 17 affected limbs was 100 / 17. The average ABI of postoperative patients was 0. 76 鹵0. 21, which was significantly higher than that of preoperative patients (P < 0. 05, P < 0. 05). One month after the operation, the limb salvage rate was 100% 17 / 17, 3 months, the limb salvage rate was 100 / 17 / 17, 6 months, the limb salvage rate was 100 / 17 / 17. One month after interventional surgery, the primary patency rate was 100 / 17 / 17, 3 months, the first stage patency rate was 94.116 / 17 / 17, the second stage patency rate was 94.11 / 16 / 17, 6 months, The patency rate of the first phase was 70.612 / 17, and the second was 88.2a / 17. Conclusion 1. The successful rate of lower extremity arteriosclerotic obliteration treated with Viabahn stent is high, the rate of limb salvage is higher and the patency rate is relatively high. 2. Choose the appropriate diameter of Viabahn stent. Better underknee outflow can improve patency rate and limb salvage rate.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R543.5;R445.1

【共引文獻(xiàn)】

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