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1、血管成形術(shù)第一節(jié)血管成形術(shù)基本概念一、PTA的定義二、PTA的發(fā)展簡(jiǎn)史三、PTA的治療機(jī)制四、PTA的適應(yīng)癥和禁忌癥五、PTA的并發(fā)癥及其預(yù)防六、PTA后再狹窄的機(jī)制七、支架成形術(shù)第一節(jié)血管成形術(shù)基本概念ClinicalManifestayionsofVascularPathologyManifestationExampleObstructiontoflowforwardArterialandvenousstenosesIncreasedflowforwardArteriovenousfistula,malformationIncreasedflo
2、wbackwardVaricoseveinsduetorefluxthroughincompetentvenousvalvesLossofvesselwallintegrityAneurysm,dissection,bleedingThesecanoccuraloneorinanycombination.第一節(jié)血管成形術(shù)基本概念A(yù)therosclerosisisanarterialdiseasethatisprevalentinindustrializednations.Veinsdonotdevelopatheroscleroticlesions
3、unlesstheyareexposedtoarterialpressuresandflowoverextendedperiodsoftime.Theriskfactorsforatherosclerosisincludeenvironmentalandgeneticfactors.Therearemultipletheoriesofcausation,includingintimaltrauma,anautoimmuneresponse,andinfection.Whatevertheunderlyingpathogenesis,thekeypo
4、inttorememberisthatatherosclerosisisasystemicdisease,affectingarteriesinallvascularbeds.第一節(jié)血管成形術(shù)基本概念RiskFactorforAtherosclerosisGeneticpredispositionSmokingDietDiabetesChronicrenalfailureHypertensionHomocysteinuriaAdvancedageHyperlipidemiaObesityElevatedlipoprotein(a)Atheromat
5、ousplaque.Eccentricatheroma第一節(jié)血管成形術(shù)基本概念第一節(jié)血管成形術(shù)基本概念A(yù)ngiographicappearanceofconcentricstenosisoftheleftcommoniliacarteryAngiographicappearanceofbulky,eccentricplaqueintheSFA第一節(jié)血管成形術(shù)基本概念Hypertrophiedcollateralarteriesaroundashortchronicocclusionofthedistalsuperficialfemoralarter
6、y(SFA).DSAshowinganabruptcutoffofflowwithafillingdefect(arrow)consistentwiththrombus.Thereisapaucityofcollateralvesselsandlackofreconstitutionofdistalvessels.第一節(jié)血管成形術(shù)基本概念I(lǐng)ntimalhyperplasiaisnotatruediseaseordisorder,butabiologicresponsetoinjurytothevesselwall.CausesofIntimalHy
7、perplasiaCauseExamplesInjurySurgicalanastomosis,clamps,angioplastydenudationofintimabyanydeviceForeignbodyStents,suturematerial,cathetersAbnormalflowArterializationofveins,turbulenceFibromuscularDysplasiaVasculitis(Takayasu'sarteritis)Otherfactorsirregularbeadedappearance(arro
8、w)andlocationoftheabnormalityinthedistalmainrenalarteryDSAarc
