《血管成形术及支架植入术精品PPT课件.ppt》由会员分享，可在线阅读，更多相关《血管成形术及支架植入术精品PPT课件.ppt（51页珍藏版）》请在金锄头文库上搜索。
1、血管成形术 1 第一节 血管成形术基本概念 一 PTA的定义 二 PTA的发展简史 三 PTA的治疗机制 四 PTA的适应症和禁忌症 五 PTA的并发症及其预防 六 PTA后再狭窄的机制 七 支架成形术 2 第一节 血管成形术基本概念 Clinical Manifestayions of Vascular Pathology Manifestation Example Obstruction to flow forward Arterial and venous stenoses Increased flow forward Arteriovenous fistula malformation
2、 Increased flow backward Varicose veins due to reflux through incompetent venous valves Loss of vessel wall integrity Aneurysm dissection bleeding These can occur alone or in any combination 3 第一节 血管成形术基本概念 Atherosclerosis is an arterial disease that is prevalent in industrialized nations Veins do n
3、ot develop atherosclerotic lesions unless they are exposed to arterial pressures and flow over extended periods of time The risk factors for atherosclerosis include environmental and genetic factors There are multiple theories of causation including intimal trauma an autoimmune response and infectio
4、n Whatever the underlying pathogenesis the key point to remember is that atherosclerosis is a systemic disease affecting arteries in all vascular beds 4 第一节 血管成形术基本概念 Risk Factor for Atherosclerosis Genetic predisposition Smoking Diet Diabetes Chronic renal failure Hypertension Homocysteinuria Advan
5、ced age Hyperlipidemia Obesity Elevated lipoprotein a Atheromatous plaque Eccentric atheroma 5 第一节 血管成形术基本概念 6 第一节 血管成形术基本概念 Angiographic appearance of concentric stenosis of the left common iliac artery Angiographic appearance of bulky eccentric plaque in the SFA 7 第一节 血管成形术基本概念 Hypertrophied colla
6、teral arteries around a short chronic occlusion of the distal superficial femoral artery SFA DSA showing an abrupt cutoff of flow with a filling defect arrow consistent with thrombus There is a paucity of collateral vessels and lack of reconstitution of distal vessels 8 第一节 血管成形术基本概念 Intimal hyperpl
7、asia is not a true disease or disorder but a biologic response to injury to the vessel wall Causes of Intimal Hyperplasia Cause Examples Injury Surgical anastomosis clamps angioplasty denudation of intima by any device Foreign body Stents suture material catheters Abnormal flow Arterialization of ve
8、ins turbulence 9 Fibromuscular Dysplasia Vasculitis Takayasu s arteritis Other factors irregular beaded appearance arrow and location of the abnormality in the distal main renal artery DSA arch aortogram showing occlusion of the left CCA arrow at the origin long stenosis of the right CCA arrowhead a
9、nd stenosis of the right subclavian artery origin Takayasu s arteritis 10 第一节 血管成形术基本概念 一 PTA的定义 经皮经腔血管成形术 Percutaneous Transluminal Angioplasty PTA 采用导管扩张 技术使狭窄或闭塞的血管开通 11 第一节 血管成形术基本概念 二 PTA的发展简史 1964年 Dotter 和 Judkins 采用同轴同导治疗 动脉粥样硬化 开创了介入 放射新纪元 同轴导管 Coaxial Catheter 血管成 形术 12 The first percutane
10、ous angioplasty 1964 A Focal stenosis in the popliteal artery arrow B Using progressively large coaxial catheters the lesion was dilated The patient s rest pain resolved and toe ulcers healed C Coaxial catheter c 13 Pre PTA Post PTA 14 第一节 血管成形术基本概念 二 PTA的发展简史 1 原理 粗大导管通过狭窄血管时产 生外向性压力 使血管腔扩大 2 缺点 入路
11、部位血管的损伤大 应用范围小 15 第一节 血管成形术基本概念 二 PTA的发展简史 1974年 Gr ntzig发明了双 腔带囊导管 球囊血管成形术 Balloon Angioplasty 1978年球囊材料进行了改进 16 PTA Balloon percutaneous transluminal angioplasty 17 第一节 血管成形术基本概念 二 PTA的发展简史 1978年Gr ntzig报导了 PTA用于肾性高血压的治 疗 同时进行了4例冠脉 PTA实验 18 第一节 血管成形术基本概念 二 PTA的发展简史 1984年Inoue 进行了二尖瓣球囊扩张 术 PTMA 的临床
12、应用研究 19 第一节 血管成形术基本概念 三 PTA的机制 控制损伤性理论 1 控制 控制球囊的直径 2 损伤 血管壁的机械性损伤 膨胀的球 囊使血管的内膜和中膜局限性撕裂 血管 壁成分 特别是中膜的过度伸展以及动脉 硬化斑块的断裂 20 Schematic of the mechanism of angioplasty A Concentric stenosis with a small residual lumen B An appropriately sized angioplasty balloon is inflated arrows in the lumen C Fracturi
13、ng fissuring and subintimal dissection of the plaque greatly increase the cross sectional area of the lumen The primary mechanism of balloon angioplasty is controlled fracture of the obstructing plaque This results in formation of fissures in the plaque itselt and tearing of the edges of the plaque
14、away from the adjacent normal intima With proper oversizing of the balloon the muscular media is stretched as well Plaque is not remodeled redistributed or vaporized by the balloon 21 Distal embolization of microscopic and occasionally macroscopic debris does occur but is usually asymptomatic Visual
15、ization of cracks or small dissections in lesions following angioplasty is a normal finding at angiography Over time these areas may remodel and the lumen resume a more normal appearance Normal angiographic appearance of an artery following angioplasty A Diseased segment of superficial femoral arter
16、y B After angioplasty with a 5 mm balloon there is fissuring arrows of the plaque This is a normal postangioplasty appearance and requires no further intervention unless it is flow limiting A B 22 第一节 血管成形术基本概念 四 PTA适应证 Indications 1 动脉粥样硬化 2 大动脉炎 3 血管搭桥术 bypass 后的吻合口狭窄 4 人造血管狭窄 5 血管肌发育不良 6 静脉血管狭窄或闭塞 23 第一节 血管成形术基本概念 五 PTA禁忌证 Contraindication 1 碘过敏 可用CO2造影 2 严重心律紊乱 心功能不全 3 肝 肾功能不全 或凝血机制异 常 4 有动脉瘤形成 5 大动脉炎活动期 24 第一节 血管成形术基本概念 六 术后并发症及预防 1 常规血管介入治疗并发症 2 远端栓塞 3 球囊破裂 4 出血 5 动脉夹层 25 balloon rupture v
