血管成形术及支架植入术.pptVIP免费

血管成形术第一节血管成形术基本概念一、PTA的定义二、PTA的发展简史三、PTA的治疗机制四、PTA的适应症和禁忌症五、PTA的并发症及其预防六、PTA后再狭窄的机制七、支架成形术第一节血管成形术基本概念ClinicalManifestayionsofVascularPathologyManifestationExampleObstructiontoflowforwardArterialandvenousstenosesIncreasedflowforwardArteriovenousfistula,malformationIncreasedflowbackwardVaricoseveinsduetorefluxthroughincompetentvenousvalvesLossofvesselwallintegrityAneurysm,dissection,bleedingThesecanoccuraloneorinanycombination.第一节血管成形术基本概念Atherosclerosisisanarterialdiseasethatisprevalentinindustrializednations.Veinsdonotdevelopatheroscleroticlesionsunlesstheyareexposedtoarterialpressuresandflowoverextendedperiodsoftime.Theriskfactorsforatherosclerosisincludeenvironmentalandgeneticfactors.Therearemultipletheoriesofcausation,includingintimaltrauma,anautoimmuneresponse,andinfection.Whatevertheunderlyingpathogenesis,thekeypointtorememberisthatatherosclerosisisasystemicdisease,affectingarteriesinallvascularbeds.第一节血管成形术基本概念RiskFactorforAtherosclerosisGeneticpredispositionSmokingDietDiabetesChronicrenalfailureHypertensionHomocysteinuriaAdvancedageHyperlipidemiaObesityElevatedlipoprotein(a)Atheromatousplaque.Eccentricatheroma第一节血管成形术基本概念第一节血管成形术基本概念AngiographicappearanceofconcentricstenosisoftheleftcommoniliacarteryAngiographicappearanceofbulky,eccentricplaqueintheSFA第一节血管成形术基本概念Hypertrophiedcollateralarteriesaroundashortchronicocclusionofthedistalsuperficialfemoralartery(SFA).DSAshowinganabruptcutoffofflowwithafillingdefect(arrow)consistentwiththrombus.Thereisapaucityofcollateralvesselsandlackofreconstitutionofdistalvessels.第一节血管成形术基本概念Intimalhyperplasiaisnotatruediseaseordisorder,butabiologicresponsetoinjurytothevesselwall.CausesofIntimalHyperplasiaCauseExamplesInjurySurgicalanastomosis,clamps,angioplastydenudationofintimabyanydeviceForeignbodyStents,suturematerial,cathetersAbnormal...