胸主动脉病变(如Stanford B型主动脉夹层、主动脉瘤、主动脉穿透性溃疡)为极其凶险疾病,对患者生命造成严重危害[1-2].传统主动脉人工血管置换方法具有较高死亡率和并发症发生率[3].目前腔内修复胸主动脉(thoracic endovascular aortic repair,TEVAR)已成为治疗胸主动脉病变的主要术式,但用于治疗累及弓上动脉、升主动脉及锚定区不足病变时仍面临挑战.本研究观察TEVAR术中应用血管腔内穿刺系统辅助原位开窗技术的效果.

目的 观察Rotarex经皮机械血栓清除术(PMT)联合药物涂层球囊(DCB)治疗股胭动脉支架内再狭窄的效果.方法 回顾性分析26例接受Rotarex PMT联合DCB治疗的股胭动脉支架内再狭窄患者,评价治疗效果,统计并发症.结果 26例手术均成功,随访期间无死亡或截肢,围手术期不良反应发生率为7.69％(2/26).术后1周Rutherford临床分级较术前降低(P=0.012).术后3、6、12个月踝肱指数(ABI)、间歇性跛行均较术前明显改善(P均＜0.05).术后6、12个月靶血管一期通畅率分别为96.15％(25/26)、84.62％(22/26),12个月免于靶血管血运重建(f-TLR)率为88.46％(23/26).结论 Rotarex PMT联合DCB治疗股胭动脉支架内再狭窄安全、有效.

目的 探讨维持性血液透析(MHD)患者血清骨唾液酸蛋白(BSP)、骨硬化蛋白(SOST)及Ca2+水平与腹主动脉钙化的关系.方法 选取2018年6月至2020年3月在本院血液净化中心规律行MHD治疗的患者70例,透析时间3个月以上;采用腹部侧位X线片来评估患者腹主血管钙化情况,计算腹主动脉钙化评分(AACs),并根据AACs评分将MHD患者分为无/轻度钙化组(AACs≤4分)和中重度钙化组(AACs>4分);所有病例透析前检测血红蛋白、白蛋白、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、糖化血红蛋白、血脂、Ca2+、磷、骨唾液酸蛋白(BSP)、骨硬化蛋白(SOST)水平.结果 70例MHD患者中,无/轻度钙化组28例(40.00％),中重度钙化组42例(60.00％);无/轻度钙化组和中重度钙化组年龄、透析龄、Ca2+、磷、BSP、SOST比较,差异有统计学意义(P<0.05);Pearson相关性分析显示,AACs与年龄、透析龄、Ca2+、磷、BSP及SOST均呈显著正相关(P<0.05);多因素Logistic回归分析提示,透析龄长(OR=1.204,95％CI:1.086～1.336),BSP水平升高(OR=1.445,95％CI:1.073～1.946)及SOST水平升高(OR=2.252,95％CI:1.353～3.749)是MHD患者腹主动脉中重度钙化的独立危险因素(P<0.05).结论 MHD患者多伴有腹主动脉钙化,透析龄长以及BSP、SOST水平增加是MHD患者腹主动脉中重度钙化的独立危险因素.

目的 观察SilverHawk斑块切除系统在治疗股腘动脉支架内再狭窄中的临床疗效.方法 回顾性分析34例股腘动脉支架内再狭窄患者的临床及随访资料,其中15例采用斑块切除术治疗(切除组),19例采用普通球囊血管成形术治疗(POBA组).术后观察两组患者临床症状改善情况,记录手术前后踝肱指数(ABI)及最小管腔直径(MLD)的变化,采用Kaplan-Meier生存函数分析术后靶血管通畅率.结果 两组手术治疗成功率均为100％.术后6、12个月切除组ABI(0.81±0.07、0.79±0.08)与POBA组(0.68±0.12、0.51±0.11)比较P均<0.05.术后12个月切除组MLD[(3.10±0.89)mm]与POBA组[(1.74±0.94)mm]比较P<0.05.术后12个月切除组靶血管一期通畅率(66.7％)高于POBA组(31.6％),P<0.05.结论 SilverHawk斑块切除系统在治疗股腘动脉支架内再狭窄病变方面具有理想的近中期临床效果,且安全有效.

Objective To investigate the efficacy of drug-coated balloon in treatment of femoropopliteal artery occlusive disease.Methods The clinical data of 49 patients with femoropopliteal artery occlusive disease from Feb 2016 to Oct 2017 were retrospectively analyzed.25 cases underwent drugcoated balloon treatment (DCB group),and 24 cases received plain balloon angioplasty (POBA group).Results The procedures were successful in all cases.There were no amputation or death occurred.In DCB group compared to POBA group,the patency rate at postoperative 3 months were not significantly different (96.0％ vs.87.5％,P ＞ 0.05),while it was significantly different at postoperative 6 and 12 months (88.0％ vs.66.7％;80.0％ vs.50.0％,both P ＜0.05).Minimal lumen diameter (MLD) changes and late lumen loss(LLL):The MLD in preoperative,immediate postoperative was not statistically significant between the three group(P ＞ 0.05).At 6 months and 12 months after operation,MLD of DCB group was higher than POBA group (P ＜ 0.05).At 12 months after surgery,LLL in DCB group was significantly lower than the POBA group (P ＜ 0.05).Conclusion DCB is the effective method to treat femoropopliteal artery occlusive disease,which has better short and mid-term efficacy than POBA.

目的 观察杂交手术治疗泛大西洋协作组织共识Ⅱ(TASCⅡ)C/D型股腘动脉硬化闭塞症的临床疗效.方法 TASCⅡ C/D型股腘动脉硬化闭塞症患者45例(52条患肢),均采用杂交手术治疗,术后观察相关临床指标,Kaplan-Meier生存曲线分析患者术后一期、二期血管通畅率情况,不同Fontaine分级间比较采用Log-Rank检验.结果 手术均顺利完成,无死亡或截肢病例.手术前后踝肱指数分别为0.31±0.15、0.77±0.35,间歇性跛行距离分别为(154±49)、(560±63)m,手术前后比较,P均<0.05.7例患者出现围手术期并发症,分别为急性心肌梗死1例、肺部感染2例、股浅动脉支架内急性血栓形成2例、切口液化坏死2例.患者术后6个月及1、2年的一期血管通畅率分别为92.31%、80.77%、71.15%,二期血管通畅率分别为98.08%、94.23%、90.38 %.Fontaine Ⅱ级患者一期血管通畅率高于Ⅲ、Ⅳ级患者(P均<0.05),Ⅲ、Ⅳ级患者之间一期血管通畅率比较P>0.05.结论 杂交手术是TASCⅡ C/D型股腘动脉硬化闭塞症的有效治疗手段,尤其适用于无法进行单纯腔内治疗的高危重症患者.

目的 探讨SilverHawk腔内斑块切除术治疗膝下动脉硬化闭塞性疾病的安全性和有效性.方法 回顾性分析28例采用SilverHawk斑块切除术治疗膝下动脉硬化闭塞症患者临床资料,通过血管多普勒超声和CT血管成像评价管腔通畅情况,记录患者手术前后踝肱指数(ABI)、并发症发生情况以及靶血管一、二期通畅率.结果 28例患者手术均获得成功.全组无围手术期死亡病例,术后所有患者临床症状较术前明显改善,术后第2天ABI 1.09±0.25与术前ABI 0.52±0.17差异有统计学意义(P<0.05).术后6、12、24个月一期通畅率分别为76.47％、70.59％、64.71％,二期通畅率分别为94.12％、91.18％、82.35％.溃疡愈合率87.5％,其中5例缺血性溃疡患者溃疡逐渐愈合;2例坏疽患者足趾脱落,创面愈合,1例坏疽患者因感染行膝下截肢,截肢平面较术前下降.结论 SilverHawk腔内斑块切除术治疗膝下动脉硬化闭塞性疾病是一种安全有效的方式,近、中期效果满意.

Objective To compare the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) and percutaneous transhepatic catheter directed thrombolysis(CDT) on acute portal vein thrombosis(PVT).Methods The clinical data of 34 patients with acute portal vein thrombosis were analyzed retrospectively.Among them,14 cases were treated with TIPS and catheter contact thrombolysis,17 cases received percutaneous transhepatic catheter thrombolysis,and 3 cases failed to be operated successfully.The thrombolytic therapeutic time,effect,complications and recurrence of PVT during the followup were compared.Results TIPS combined with CDT were successfully created in 14 patients.The mean thrombolytic therapeutic time was 7.2 days,and portal veins were recanalized more than 75.0％ by imaging finding in 11 patients (78.6％).Four patients(28.6％) had complications.During follow-up,1 patient (7.1％) had recurrence of thrombus.In the 17 cases treated by percu-taneous transhepatic catheter thrombolysis,the mean postoperative time of thrombolysis was 10.1 days,portal vein recanalization (＞75.0％) examed by X-ray occurred in 6 cases(35.3％),8 cases experienced complications (47.1％),during the follow-up 7 cases (41.2％) suffered recurrent thrombosis.After TIPS and catheter directed thrombolysis,the thrombolysis time was shortened (P =0.033),the recanalization rate of portal vein (＞ 75％) was higher (P =0.029),and the recurrence rate of thrombus was low (P =0.045).Conclusions Both the two methods are effecive in the treatment of acute PVT,and TIPS combined with CDT may be better.

Objective To explore the value of retrograde recanalization technique in treatment of TASCⅡ C/D femoropopliteal arteriosclerosis obliterans.Methods Totally 36 patients with TASCⅡ C/D femoropopliteal arteriosclerosis obliterans were retrospectively analyzed.Preoperative and postoperative ankle brachial index (ABI) and intermittent claudication were compared,as well as postoperative vascular patency rate and complications were analyzed.Results The retrograde recanalization technique were successfully performed in all 36 patients.The walking distance and ABI of 7 days,and 3,6,12 months postoperation were increased significantly compared with preoperation (all P＜0.05).The postoperative vascular patency rate of 3,6 and 12 months was 97.22％,91.67％ and 72.22％,respectively.There was no death nor amputation during the follow-up period,and the incidence of perioperative complications was 11.11 ％ (4/36).Conclusion Retrograde recanalization technique can be used to treat TASC Ⅱ C/D femoropopliteal arteriosclerosis obliterans when anterograde access failed.

目的：评价杂交手术治疗TASC D型主髂动脉硬化闭塞症的临床疗效。方法：回顾性分析2012年3月至2014年3月在血管外科治疗的28例TASC D型主髂动脉硬化闭塞症患者的临床资料，观察围手术期结果及血管再通情况。结果：28例杂交手术均获得成功，手术成功率100％，无截肢及死亡病例，围手术期并发症发生率17．85％（5／28），平均间歇性跛行距离从术前（75±64） m 提高至术后（468±92）m （P ＜0．01），踝肱指数由术前（0．21±0．16）增至术后（0．72±0．12）（P ＜0．05），平均随访（25±7．9）个月，术后6个月，1、2年的一期通畅率分别为96．4％，89．2％，85．7％，术后6 个月，1、2年二期通畅率分别为100％，96．4％，92．9％。结论：杂交手术是治疗TASC D型主髂动脉硬化闭塞症的安全、有效方法，尤其适用于高危重症患者。

Objective:To evaluate the clinical effcacy of hybrid therapy for TASC C/D aortoiliac arteriosclerosis obliterans. Methods:hTe clinical data of 48 patients (66 limbs) with TASC C/D (including TASC C in 22 cases and TASC D in 26 cases) aortoiliac arteriosclerosis occlusive diseases undergoing hybrid revascularization procedures from May 2012 to May 2014 were analyzed. hTe perioperative conditions were evaluated, the revascularization results among patients with different Fontaine classiifcations were compared, and the inlfuential factors for primary patency were analyzed. Results:hTe hybrid procedures were successfully performed in all 48 patients (66 limbs), and technical success rate was 100%. One patient underwent amputation on postoperative day 5 due to severe gangrene and infection of the lower limb, but no death occurred and the incidence of perioperative complications was 16.67%. The postoperative distance of intermittent claudication (568 m vs. 92 m) and ankle-brachial index (0.75 vs. 0.25) were signiifcantly higher than those before operation (both P<0.05). hTe average period of follow-up was 24 months,the 6-month and 1-and 2-year primary patency rate was 95.45%, 90.91%and 87.88%, and secondary patency rate was 98.48%, 96.97%and 92.42%, respectively. hTe primary patency rate in patients with Fontaine stage II and III were signiifcantly higher than that in patients with Fontaine stage IV (P=0.036, 0.015), which however had no statistical difference between patients with Fontaine stage II and III (P>0.05). hTe presence of diabetes and dyslipidaemia were independent risk factors for decreased primary patency (P=0.026, 0.003). Conclusion:Hybrid therapy is a safe and effective treatment for TASC C/D aortoiliac arteriosclerosis obliterans.