膝下血管腔内治疗策略教程教案

膝下血管腔内治疗策略庄百溪现状患病率升高

老龄化年代、糖尿病人、不良生活习惯导致动脉硬化发生率增高发病率升高

检查手段改善，更多的发现膝下病变就诊多为晚期患者知晓率低，医师敏感度差闭塞动脉开通率低多为多支长段严重钙化的闭塞经济负担重（放置支架的可能性增大）、忍受痛苦（截肢、截趾发生率高）现有治疗策略通常对间歇性跛行患者不实施膝下腔内治疗UseofthistechniqueisusuallynotindicatedinpatientswithintermittentclaudicationTASCIIF3.2Endovasculartreatmentofinfrapoplitealocclusivedisease对吗？由于膝下血管管径较小，一旦发展为完全闭塞，再次开通的机会将大大降低，给临床工作带来极大的困难短段病变如没有被积极治疗，会逐渐在远近端形成血栓，进而机化，进展为长段完全闭塞，给治疗带来更多困难所以，我们应该提倡及早治疗血管病变从手术角度也要求及早治疗膝下血管病变常见膝下病变类型穿刺点选择尽可能采用同侧顺行穿刺，可获得更佳的导丝操控性伴有髂股动脉病变的患者，可采用对侧穿刺，方便同期治疗髂、股腘动脉病变术中治疗策略三支血管各有作用，当某一支血管病变时，相应供血区域会出现症状尤其伴有糖尿病患者，侧枝循环较差，更易出现仅单支血管病变就导致CLI的现象术中尽可能开通全部病变血管，建立直达足部血流（in-lineflowtothefoot）DPATDPAT膝下支架术前扩张后支架后膝下支架膝下支架术前球扩后支架后强调足底、足背动脉弓的重要意义总结腔内治疗膝下血管病变应早期诊断，早期治疗术中尽可能开通全部病变血管，建立直达足部血流（in-lineflowtothefoot）重视足底动脉弓及足背动脉弓多学科合作，注重预防和治疗Thetibials:EndovascularTreatmentStrategiesBAIXIZHUANGTheStatusHighMorbidityrateaging、diabetic、foodanddrinkhadmademorearteriosclerosisHighMorbilityrate

advancedmethodcanfindmoreBTKlesionMostpatientswereCLIpoorawarenes，doctorpaylessattentionHardtoopenocclusion

multi-branch,longsegment,severecacificationChargewillhigher（Possibilityofstentishigher）、sufferpain（higheramputationrate）StrategiesaboutEndovasculartreatmentofinfrapoplitealocclusivediseaseinTASCIIAngioplastyofashortanteriororposteriortibialarterystenosismaybeperformedinconjunctionwithpoplitealorfemoralangioplasty.Useofthistechniqueisusuallynotindicatedinpatientswithintermittentclaudication.

TASCIIF3.2EndovasculartreatmentofinfrapoplitealocclusivediseaseWhenisthebesttime？Strategiesaboutcoronaryarterydisease：myocardialinfarct？anginapectoris！Thesametoleg！stenosis、singlelesionshouldbetreatedintime,especiallyfordiabeticTreatfootliketreatheart！CommonBTKlesion

WheretopunctureAntegradepunctureasposibleasyoucan，youcancontrolthewiremoreeasyStrategieswhenoperationEachbranchhasitsrole.LesioninonebranchmayinduceCLIincorrespondingsupplyarea,especiallyinpeoplewithdiabetesforthelackofcollateralcirculationWeshouldmadein-lineflowtothefoot!DPATDPATBTKstent术前扩张后支架后BTKstentBTKstent术前球扩后支架后importantStatusofpedalandplantararchveryimportantSummaryTheearlierthebetterWeshouldmadein-linefl