血管成形術(shù)及支架植入術(shù)(編輯修改稿)
2024-10-31 12:02 本頁面
【文章內(nèi)容簡介】 制：控制球囊的直徑 損傷：血管壁的機械性損傷，膨脹的球囊使血管的內(nèi)膜和中膜局限性撕裂，血管壁成分，特別是中膜的過度伸展以及動脈硬化(d242。ngm224。iy236。nghu224。)斑塊的斷裂。,第二十頁，共五十一頁。,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, Fracturing, fissuring, and subintimal dissection of the plaque greatly increase the crosssectional 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 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.,第二十一頁，共五十一頁。,Distal embolization of microscopic and, occasionally, macroscopic debris does occur, but is usually asymptomatic. Visualization 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 artery. B, After angioplasty with a 5mm balloon, there is fissuring (arrows) of the plaque. This is a normal postangioplasty appearance and requires no further intervention unless it is flowlimiting.,A B,第二十二頁，共五十一頁。,第一節(jié) 血管(xu232。guǎn)成形術(shù)根本概念,四、PTA適應(yīng)證〔Indications) 動脈粥樣硬化 大動脈炎 血管搭橋術(shù)〔bypass) 后的吻合(wěnh233。)口狹窄 人造血管狹窄 血管肌發(fā)育不良 靜脈血管狹窄或閉塞,第二十三頁，共五十一頁。,第一節(jié) 血管(xu232。guǎn)成形術(shù)根本概念,五、PTA禁忌證(Contraindication) 1. 碘過敏(gu242。mǐn)〔可用CO2造影〕。 2.嚴重心律紊亂，心功能不全。 3.肝、腎功能不全，或凝血機制異常 4.有動脈瘤形成 5.大動脈炎活動期。,第二十四頁，共五十一頁。,第一節(jié) 血管(xu232。guǎn)成形術(shù)根本概念,六、術(shù)后并發(fā)癥及預(yù)防 常規(guī)血管介入治療并發(fā)癥 2 、遠端栓塞 球囊破裂(p242。li232。) 出血 動脈夾層,第二十五頁，共五十一頁。,balloon rupture,vessel rupture,第二十六頁，共五十一頁。,第一節(jié) 血管(xu232。guǎn)成形術(shù)根本概念,七、PTA后再狹窄(xi225。zhǎi)機制 急性再狹窄 早期再狹窄 晚期再狹窄,第二
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