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1、BTKA支架的应用汤敬东血管外科上海交通大学附属第一人民医院2BTKA: below-the knee (BTK) arterial广义狭义要不要BTK过不过现在已不是问题，到哪里才是问题。我院资料（狭义BTKA）16例，男11例，女5例胫腓干9例，胫前1例，腓4例，胫后2例（DES）随访246月通畅：胫腓干8例，胫前1例，腓3例，胫后0例THE JOURNAL OF CARDIOVASCULAR SURGERY The Journal of Cardiovascular Surgery 2012 February;53(1 Suppl 1):179-88Results of the “end
2、ovascular treatment first” policy for infrapopliteal diseaseEven though differences between first-bypass vs. first-endovascular approach in below the knee (BTK) lesions have never been adequately compared, endovascular strategy first approach can be currently successfully used to treat BTK lesions i
3、n patients with critical limb ischemia (CLI). Success however is strongly associated with risk groups, severity of disease and degree of clinical presentation beside the method of revascularization. From available data, the best results of endovascular first approach for BTK lesions can be achieved
4、with multivessel and tibial (more than peroneal alone) recanalization and Rutherford 4 or 5 ischemia changes, especially if the correct angiosome can be revascularized (direct flow to the feeding artery of the foot) and there is no renal failure. For patients in Rutherford class 6 and extensive gang
5、rene/tissue loss, BTK endovascular strategy alone does not seem to provide ideal results. Outcomes of interventional therapy for BTK lesions are consistently better when applied in experienced centers with the use of more advanced technology and use of eluting materials. According to limited but ran
6、domized evidence, drug-eluting stent (DES) placement might be recommended in BTK lesions under 40 mm long since yields significantly better results than angioplasty alone or implantation of bare metal stents in this lesion subset. Nevertheless, this policy raises doubts on the efficacy of treatment
7、due to limitations in generalizability of outcomes in common hospital settings and related costs. Furthermore, there are still no consistent numbers to provide the efficacy of this approach and long-term data are lacking. Waiting for the long-term results of ongoing trials and new researches, a more
8、 comprehensive analysis of outcomes with BTK endovascular first strategy can be provided in the next future.For patients in Rutherford class 6 and extensive gangrene/tissue loss, According to limited but randomized evidence, drug-eluting stent (DES) placement might be recommended in BTK lesions unde
9、r 40 mm long since yields significantly better results than angioplasty alone or implantation of bare metal stents in this lesion subset.European Journal of Vascular and Endovascular Surgery Volume 47, Issue 5, Pages536544, May 2014Randomized Trials for Endovascular Treatment of Infrainguinal Arteri
10、al Disease: Systematic Review and Meta-analysis (Part 2: Below the Knee)ResultsTwelve trials including 1145 patients were identified, with 90% of patients having CLI. Six BS versus PTA and two DES versus PTA trials showed low-quality evidence of equal efficacy. One trial, comparing DEB with PTA, sho
11、wed moderate-quality evidence of improved wound healing (RR 1.28; 95% CI: 1.05 to 1.56; p=.01), improvement in Rutherford classification (RR 1.32; 95% CI: 1.08 to 1.60; p=.008), and lower TLR (RR 0.41; 95% CI 0.23 to 0.74; p=.002) and binary restenosis (RR 0.36; 95% CI 0.24 to 0.54; p.0001) in diabe
12、tic patients after 12 months. Amputation and death rate did not differ significantly. For DES versus BS, most trials showed equal efficacy between strategies.Six BS versus PTA and two DES versus PTA trials showed low-quality evidence of equal efficacyFor DES versus BS, most trials showed equal efficacy between strategies. 腘动脉脉 (POP)4-6 mm胫前前动脉脉 (AT) 2-4 mm胫腓干腓干 2-4 mm胫后后动脉脉 (PT) 2-4 mm腓腓动脉脉 2-4 mm下肢缺血病变率：胫前动脉病变率：64.5%胫后动脉病变率：59.9%腓动脉病变率：31.6%2+2+2=6远端流出道是关键要将革命进行到底谢谢!
