Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Kendall, FL.
Herbert Wertheim College of Medicine, Florida International University, Miami, FL.
Tech Vasc Interv Radiol. 2022 Sep;25(3):100843. doi: 10.1016/j.tvir.2022.100843. Epub 2022 Jun 6.
In the management of patients with critical limb ischemia endovascular revascularization plays a crucial role improving amputation-free survival, ischemic rest pain, and wound healing. Endovascular standard of care of peripheral arterial occlusive disease involves angioplasty and/or stent placement. The following discussion is intended to familiarize interventional physicians with the rationale, physiological concepts, and technical approach to developing endovascular procedures-percutaneous femoropopliteal bypass and percutaneous deep vein arterialization. Percutaneous arterial bypass procedure is designed to treat long complex Trans-Atlantic Inter-Society Consensus C and D hemodynamically significant superficial femoral artery lesions by redirecting the flow of blood from the diseased arterial segment through a femoral vein conduit. Percutaneous deep vein arterialization is used for selected "no-option" critical limb ischemia patients who cannot undergo or have failed conventional endovascular and/or surgical revascularization due to extensive occlusion of the outflow arteries. It involves creation of an arteriovenous fistula between a tibial artery and a tibial vein, disruption of venous valves, and elimination of venous collaterals. The consequent arterialization of the distal venous bed enables delivery of oxygenated pressurized arterial blood to the ischemic tissues, stimulating angiogenesis and increasing flow in the existent collateral vessels, which in turn will improve limb salvage and amputation free survival.
在治疗严重肢体缺血患者中，血管腔内治疗发挥着重要作用，可以提高保肢生存率、缓解缺血性静息痛和促进伤口愈合。外周动脉闭塞性疾病的血管腔内标准治疗包括血管成形术和/或支架置入术。以下讨论旨在使介入医师熟悉开发血管腔内手术——经皮股腘旁路和经皮深静脉动脉化的基本原理、生理概念和技术方法。经皮动脉旁路术旨在通过从病变动脉段经股静脉导管重新引导血流，来治疗长段复杂的经 Trans-Atlantic Inter-Society Consensus C 和 D 血流动力学显著的股浅动脉病变。经皮深静脉动脉化术用于特定的“别无选择”严重肢体缺血患者，这些患者由于流出动脉广泛闭塞，不能进行或已经失败了传统的血管内和/或手术血运重建。它涉及在胫动脉和胫静脉之间创建动静脉瘘，破坏静脉瓣膜，并消除静脉侧支循环。随后，远端静脉床的动脉化使富含氧的加压动脉血流能够输送到缺血组织，刺激血管生成并增加已存在的侧支血管的血流，这反过来将提高肢体挽救率和免于截肢的生存率。
