Peripheral artery recanalization in humans using balloon and laser angioplasty.
Peripheral artery recanalization in humans using balloon and laser angioplasty.
复制标题
使用球囊和激光血管成形术对人体进行外周动脉再通。
DOI：
10.1002/clc.4960190318
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发表时间：
1996
影响因子：
2.7
通讯作者：
Abela,GS
中科院分区：
文献类型：
--
作者：
Barbeau,GR;Seeger,JM;Jablonski,S;Kaelin,LD;Friedl,SE;Abela,GS
对于患有复杂外周动脉疾病的患者和那些先前尝试血管重建术失败的患者的治疗在临床上可能是具有挑战性的。最初的治疗是使用经皮球囊和激光血管成形术治疗，如果严重缺血持续，则继续进行搭桥手术。采用经皮和切开两种途径进入完全闭塞的动脉。试图用导丝或激活的激光探头机械地穿过咬合。如果激光再通不成功，患者接受搭桥手术或药物治疗，除非有必要截肢。在对381名患者进行初步筛查后，103名患者进行了115次手术。在31例(28例)手术中，仅行球囊血管成形术。在84例(75例)手术中，尝试了激光再通：55例经皮，29例切开。总的技术成功率(无穿孔穿越梗阻)为86/115(75%)。技术上成功的手术的特点是动脉闭塞的时间比技术上失败的短(8.4cmvs.14.3±1.9cmp<；0.004)。单纯球囊血管成形术的患者中有22/31(71%)获得了临床成功(残余狭窄50%，症状缓解，踝臂指数≥改善0.15，无并发症)。狭窄程度由98±4%降至31±24%，P<0.00001。激光联合球囊血管成形术的技术成功率为65%(36/55)。狭窄在激光血管成形术后从99±2%减少到56±14%，在球囊血管成形术后减少到30±15%，p<；0.0001。切开激光血管成形术的临床成功率为9/29(31%)。然而，严重的并发症很少见。外周血管疾病的设备分期为手术风险较高和/或标准治疗失败的患者提供了额外的选择。
The treatment of patients with complex peripheral arterial disease and those who have had previous unsuccessful attempted revascularization procedures can be clinically challenging. Initial treatment was begun using therapy by percutaneous balloon and laser angioplasty, then proceeding to bypass surgery if severe ischemia persisted. Both percutaneous and cut‐down approaches were used to access totally occluded arteries. An attempt was made to cross the occlusion mechanically with either a guide wire or an activated laser probe. If laser recanalization was not successful, the patient underwent bypass surgery or was managed with medication unless an amputation was necessary. Following initial screening of 381 patients, 115 procedures were performed on 103 patients. In 31 procedures (28 patients), only balloon angioplasty was performed. In 84 procedures (75 patients), laser recanalization was attempted: 55 percutaneously and 29 by cut‐down. Overall technical success (crossing the obstruction without perforation) was 86/115 (75%). Technically successful procedures were characterized by shorter arterial occlusions than were technical failures (8.4 ± 1 cm vs. 14.3 ± 1.9 cm; p< 0.004). Clinical success (residual stenosis < 50%, symptom relief, improved ankle brachial index ≥ 0.15, and no complications) was achieved in 22/31 (71 %) of balloon angioplasty procedures alone. The stenoses decreased from 98 ± 4% to 31 ± 24%, p < 0.00001. Combined percutaneous laser and balloon angioplasty had a technical success of 36/55 (65%). Stenoses were reduced from 99 ± 2% to 56 ± 14% after laser angioplasty, to 30 ± 15% after balloon angioplasty, p < 0.0001. Laser angioplasty performed via a cut‐down had a clinical success of 9/29 (31%). However, major complications were rare. Device staging for treatment of peripheral vascular disease provides additional options for patients who are at high surgical risk and/or in whom standard therapy has failed.