血管成形术及支架植入术VIP免费

血管成形术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、支架成形术第一节血管成形术基本概念ClinicalManifestayionsofVascularPathologyManifestationExampleObstructiontoflowforwardArterialandvenousstenosesIncreasedflowforwardArteriovenousfistula,malformationIncreasedflowbackwardVaricoseveinsduetorefluxthroughincompetentvenousvalvesLossofvesselwallintegrityAneurysm,dissection,bleedingThesecanoccuraloneorinanycombination.第一节血管成形术基本概念Atherosclerosisisanarterialdiseasethatisprevalentinindustrializednations.Veinsdonotdevelopatheroscleroticlesionsunlesstheyareexposedtoarterialpressuresandflowoverextendedperiodsoftime.Theriskfactorsforatherosclerosisincludeenvironmentalandgeneticfactors.Therearemultipletheoriesofcausation,includingintimaltrauma,anautoimmuneresponse,andinfection.Whatevertheunderlyingpathogenesis,thekeypointtorememberisthatatherosclerosisisasystemicdisease,affectingarteriesinallvascularbeds.第一节血管成形术基本概念RiskFactorforAtherosclerosisGeneticpredispositionSmokingDietDiabetesChronicrenalfailureHypertensionHomocysteinuriaAdvancedageHyperlipidemiaObesityElevatedlipoprotein(a)Atheromatousplaque.Eccentricatheroma第一节血管成形术基本概念第一节血管成形术基本概念AngiographicappearanceofconcentricstenosisoftheleftcommoniliacarteryAngiographicappearanceofbulky,eccentricplaqueintheSFA第一节血管成形术基本概念Hypertrophiedcollateralarteriesaroundashortchronicocclusionofthedistalsuperficialfemoralartery(SFA).DSAshowinganabruptcutoffofflowwithafillingdefect(arrow)consistentwiththrombus.Thereisapaucityofcollateralvesselsandlackofreconstitutionofdistalvessels.第一节血管成形术基本概念Intimalhyperplasiaisnotatruediseaseordisorder,butabiologicresponsetoinjurytothevesselwall.CausesofIntimalHyperplasiaCauseExamplesInjurySurgicalanastomosis,clamps,angioplastydenudationofintimabyanydeviceForeignbodyStents,suturematerial,cathetersAbnormalflowArterializationofveins,turbulenceFibromuscularDysplasiaVasculitis(Takayasu'sarteritis)Otherfactorsirregularbeadedappearance(arrow)andlocationoftheabnormalityinthedistalmainrenalarteryDSAarchaortogramshowingocclusionoftheleftCCA(arrow)attheorigin,longstenosisoftherightCCA(arrowhead),andstenosisoftherightsubclavianarteryoriginTakayasu'sarteritis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（PercutaneousTransluminalAngioplasty,PTA）：采用导管扩张技术使狭窄或闭塞的血管开通。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(CoaxialCatheter)血管成形术Thefirstpercutaneousangioplasty,1964.A,Focalstenosisinthepoplitealartery(arrow).B,Usingprogressivelylargecoaxialcatheters,thelesionwasdilated.Thepatient'srestpainresolvedandtoeulcershealed.C,Coaxialcatheter.cPre-PTAPost-PTA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：入路部位血管的损伤大，应用范围小。第一节血管成形术基本概念二、PTA的发展简史1974年，Grüntzig发明了双腔带囊导管—球囊血管成形术(BalloonAngioplasty)。1978年球囊材料进行了改进。PTA-Balloon(percutaneoustransluminalangioplasty)第一节血管成形术基本概念二、PTA的发展简史1978年Grüntzig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。第一节血管成形...