膝下动脉闭塞腔内治疗热点问题——实践与思考  

Endovascular treatment of infrapopliteal artery occlusion: clinical practice and thinking of present hot issues

作　　者：杨硕菲[1] 张岚[1] 

机构地区：[1]上海交通大学医学院附属仁济医院血管外科,200127

出　　处：《介入放射学杂志》2017年第6期481-485,共5页Journal of Interventional Radiology

摘　　要：重症下肢缺血(CLI)是下肢动脉硬化闭塞症重度期表现,膝下动脉闭塞是导致CLI重要原因,保肢、提高生活质量是CLI治疗目标。随着技术和器械发展,腔内治疗成为膝下动脉病变的主要治疗方法。由于膝下动脉独特的解剖特点、治疗难度大、再狭窄发生率高,一系列争议性问题产生:首选腔内治疗还是传统旁路手术,膝下动脉治疗靶血管如何选择,膝下动脉腔内治疗入路如何选择,腔内治疗术式如何优化等。本文结合最新循证医学证据和临床治疗经验,就膝下动脉闭塞腔内治疗上述热点问题的实践与思考作一阐述。Critical lower limb ischemia（CLI） is a severe manifestation of arteriosclerosis obliterans of lower extremity, infrapopliteal artery occlusion is an important cause of CLI. Both limb salvage and life quality improvement are therapeutic targets for CLI. With the development of technology and equipment, endovascular treatment has become the main means for infrapopliteal arterial occlusive diseases. Because of the unique anatomic features of infrapopliteal artery, great therapeutic difficulty and high incidence of restenosis, a series of controversial issues have been emerged. The main controversial issues are as follows： （1） Which should be taken as first choice of treatment, endovascular therapy or traditional bypass surgery？ （2） How to select target vessels in treating infrapopliteal artery occlusion？ （3） How to select optimal access in performing endovascular treatment of infrapopliteal artery？ （4） How to optimize the endovascular surgical method for infrapopliteal arterial occlusive disease？ Based on the latest advance in evidence-based medicine and on the clinical treatment experience, this paper aims to make a detailed description concerning the above mentioned hot issues in clinical practice as well as in academic consideration about endovascular treatment of infrapopliteal arterial occlusive diseases.（J Intervent Radiol, 2017, 26： 481-485）

关 键 词：下肢动脉硬化闭塞症 膝下动脉闭塞 腔内治疗 重症下肢缺血 

分 类 号：R543.5[医药卫生—心血管疾病]