1、膝下动脉病变腔内治疗体会 山东省立医院血管外科 张十一 董典宁 王默 徐磊 孙岩 王茂华 “ No option CLI patients” No Surgical options No easy Endovascular option In some cases, Amputation is the only option BUT Endovascular Rx is to minimise the level and promote stump healing CLI Multidisciplinary Therapy Awareness and prevention Early Diag
2、nosis Treatment WOUND CARE 1.Debridement 2.Off-loading 3.Antibiotics 4.Skin Graft 5.Rehabilitation 6.Best Medical Therapy REVASCULARIZATION Multiple Therapy Options Angioplasty POBA Drug Coated Balloons Atherectomy Balloon Expandable Stents Self-Expanding Stents Bare Metal Stents Drug Eluting Stents
3、 Covered Stents Bioresorbable Vascular Scaffolding (BVS) Bare BVS Drug Eluting BVS Indications SIA Long occlusive disease Popliteal occ. Extending into trifurcation Good target vessel PTA Heavy Ca+ (Renal Impaired patients) Severe diffuse disease (Diabetic patients) Poor target vessel Reconstitution
4、 of the pedal arcade How improve the results? Recanalization of BTK-occlusions Unsuccessful in up to 20-30% . Operator skill New techniques Angiosome Concept SIA RECONSTITUTION of the ARCADE Only done in selected situations There is a risk to damage of the digital artery origins if the dissection ex
5、tends along the origin of these arteries MULTIPLE VESSEL RECANALISATION 3 main reasons: a) Improved total foot perfusion b) Better SFA patency with 3 vessel run-off c) Insurance against blockage Is SIA an option? Is SIA an option? It is almost a requirement in many cases Without it, success may not
6、be achieved WHY? - SIA is needed CLI = Tibial occlusive disease Long occ. / Trifurcation disease SIA advantages: Primary Success (already high, 90%) Durability (aim for best haemodynamics) - correct flow limiting situation - provide as many run-off vessels as possible (more run-off vessels = better patency) Repeatability (c.f. stent)
