Rand T, Haumer M, Stadler A, Schoder M, Kettenbach J
Klinische Abteilung für Angiographie und Interventionelle Radiologie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090 Vienna, Austria.
Radiologe. 2006 Nov;46(11):948-54. doi: 10.1007/s00117-006-1426-z.
Although angioplasty and stent applications in the iliac vessels and the superficial femoral artery have become routine procedures, their usefulness for the treatment of lesions of the popliteal artery and the lower leg arteries is still under discussion. For the popliteal artery, limitations are mainly due to the high mechanical stress in this area, causing high traction forces. Moreover, beyond the occlusive atherosclerotic changes, specific pathological entities such as aneurysms, emboli, entrapment syndromes, and cystic adventitial disease have to be differentiated. There is hope that the development of innovative stent designs with high flexibility might overcome the limitations. For lesions of the lower leg arteries treatment with percutaneous transluminal angioplasty (PTA) has become the method of choice. However, stent designs as used for cardiac interventions have been adapted for their application below the knee, and first encouraging results may help to justify their broad use in the future. Regarding PTA, innovative equipment and techniques for the treatment of arterial lesions below the knee include dedicated, long, and very flexible balloons, cutting balloon cryoplasty, and laser angioplasty. Regarding stents, bare metal stents, stents with passive or active coatings, and bioabsorbable stents have all been successfully used.
尽管在髂血管和股浅动脉中进行血管成形术和支架置入已成为常规手术，但它们在治疗腘动脉和小腿动脉病变方面的有效性仍在讨论中。对于腘动脉，局限性主要是由于该区域的机械应力较高，会产生较大的牵引力。此外，除了闭塞性动脉粥样硬化改变外，还必须区分特定的病理实体，如动脉瘤、栓子、卡压综合征和囊性外膜疾病。人们希望，具有高柔韧性的创新支架设计的开发可能会克服这些局限性。对于小腿动脉病变，经皮腔内血管成形术（PTA）已成为首选治疗方法。然而，用于心脏介入治疗的支架设计已被调整用于膝下应用，初步令人鼓舞的结果可能有助于证明其未来广泛应用的合理性。关于PTA，用于治疗膝下动脉病变的创新设备和技术包括专用的、长的且非常柔韧的球囊、切割球囊冷冻成形术和激光血管成形术。关于支架，裸金属支架、带有被动或主动涂层的支架以及生物可吸收支架都已成功使用。
