优化腹股沟下动脉血管内重建术效果的方法(文献复习)

O.L. Nikishyn, I. Altman, I.I. Al-Qashgish, A. I. Gavretskiy, S. I. Savoluk, M.I. Mus
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引用次数: 0

摘要

随着先进技术的发展,微创手术在外科手术中越来越广泛,与传统的开放手术相比,微创手术具有许多优点。在血管外科中,血管内血运重建术在下肢闭塞性疾病的治疗中越来越重要。然而,有一些挑战限制了血管内血运重建术的有效性,并增加了技术失败的可能性。下肢动脉血管内重建的主要挑战之一是在内膜下血管成形术中重新进入血管腔。在某些情况下,特别是当血管壁有严重的动脉粥样硬化或钙化时,使用标准的钢丝环技术可能并不总是允许重新进入血管的真正管腔,并且进行其他手术干预可能受到限制甚至不可能。提高内膜下血管成形术的成功率将提高血管内血管重建术与开放式和混合式重建手术相比的竞争力。已经提出了几种技术来优化血管内血运重建术的结果,包括SAFARI技术,它结合了顺行和逆行通道来穿越复杂的闭塞。在导管尖端装有特殊弯曲针的再入装置用于将0.014英寸的导线引导到血管的真正管腔中。由马达驱动的高速旋转刀片的动脉粥样硬化切除术装置也被用来破坏钙化斑块,通过其他方式无法通过的严重钙化闭塞形成通道。这些方法可以单独或联合使用,以优化血管内血运重建的结果。我们根据文献资料分析了执行上述程序的技术方面及其临床结果。根据已发表的数据,应用优化腹股沟下动脉血管内重建术结果的方法,使这些手术的成功率提高到≥90%。这些方法的广泛使用受到再入和动脉粥样硬化切除装置的高成本的阻碍。积累自己的经验将有助于提高慢性腹股沟下动脉闭塞患者血管成形术的有效性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Methods of optimizing the results of endovascular revascularization of infrainguinal arteries (literature review)
With the development of advanced technologies, minimally invasive methods are becoming increasingly widespread in surgery, offering several advantages compared to traditional open surgery. In vascular surgery, endovascular revascularization methods are gaining increasing importance in the management of lower limb occlusive diseases. However, there are certain challenges that limit the effectiveness of endovascular revascularization and increase the likelihood of technical failure. One of the major challenges in endovascular revascularization of lower limb arteries is achieving re-entry into the vessel lumen during subintimal angioplasty.In certain cases, especially when there is severe atherosclerotic involvement of the vessel wall or calcification, the use of standard wire loop techniques may not always allow for re-entry into the true lumen of the vessel, and performing other surgical interventions may be limited or even impossible. Increasing the success rate of subintimal angioplasty will enhance the competitiveness of endovascular revascularization compared to open and hybrid reconstructive surgeries.Several techniques have been proposed to optimize the outcomes of endovascular revascularization, including the SAFARI technique, which combines antegrade and retrograde access for traversing complex occlusions. Re-entry devices equipped with specially curved needles at the catheter tip are used to direct the 0.014 inch wire into the true lumen of the vessel. Atherectomy devices with high-speed rotating blades driven by a motor are also employed to disrupt calcified plaques, creating a passage through heavily calcified occlusions that cannot be traversed by other means. These methods of optimizing the outcomes of endovascular revascularization can be used individually or in combination.We have analyzed the technical aspects of performing the mentioned procedures and their clinical outcomes based on literature sources. According to published data, the application of methods to optimize the outcomes of endovascular revascularization of infrainguinal arteries increases the success rate of these procedures to ≥90%. The widespread use of these methods is hindered by the high cost of re-entry and atherectomy devices. Accumulating our own experience will help improve the effectiveness of angioplasty in patients with chronic infrainguinal artery occlusions.
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