Эндоваскулярная хирургия диабетической стопы:...

1. .. . 5 2011.,

: (diabetic foot) , / , , 3. : 6070 % - 510 % (-) - 2030 %. 4. : 10-15 45-50% 5- 50% 2-3 5. : / () 4 , - 8 6. :

7. - 2007 : / () 8.

90 % :

9. - : ( , , ), !!! : 10. 1993-20 10.-424 ; 362(84%)-,,; 2 51(58,4%)- : : -424 .-326 (): .-98 (100%) . -277( 84,9 % ) 4 ( 1 %) - 3 (0,85%) 11.

12. -53 - 50 -3 -1 -50 -47 (94,0%)Pedal arteries puncture- 44 Tibialcollaterals-4 loop technique-2SheathlessApproach-25 4F Sheath-19ATA-20 PTA-17PA-13 13. - 47 -27 (57,4%) - -1- -1 -25 PTA -29 (61,7%) F/U (1-60 ): >50%-8( 18,1%)-2(4,5%) -50 -47 ( 94,0% ) 14. -65-87% + ( ) -53 - 50 -3 -1 -50 -47 ( 94,0% ) 15. - 74 - 46 -8 ( 4 ) ( ) , : : 16. 12 . :10 1 9 7 50 % -3 9 - 50 %-2 9 (13,5%) (9 20 )-3 5( 15 %) 24 4 64( 24,7 %) 244. 9 : 12 .-4 - ?! 12 .-2+2 ?! 17. 18.

: 19. -0.014 ;0.018 ; 0.035 - - :- - - 20.

- , 2 b 3 a

21. .... Pre-op 22. Retrograde recanalization via posterior perforatingcollateral branch 0.014 Pilot 200 wire (Abbott), OTW balloon 1.5-15 (Boston) 23. Retrograde antegradewiring Balloon Dilatation and Stenting Suboptimal result Antegradewiring Stenting DES Antegrade long balloon 24. Final angio ISRDEB PTA Good distal flow 25. Loop Technique Occluded distal PTA Plantara.Retrograde wiring Finecross support Retrograde PTA Failed antegrade recanalization 26. Retrograde and Antegrade wiring Antegrade Long balloon PTA Final angio Final angio Loop Technique 27. : MSCT Angiography: : ,, , 28. 6 Fr 30 cm sheath Flexor (COOK) PTA + StentingLeft EIA -ZA-stent (COOK) 8.0/80 mm 29. Hydrophilic wire 0.035 (COOK and Terumo) 30. Outback - Re-EntryDevice(Cordis) 31. Pedal Artery Puncture 21Gneedle Technique of Transpedal Approach 1 .SheathlessApproach : 0.014 wire + OTWBalloon 1,5/15 2.Sheath 4 F-0.018or0.035 wire

After wirecrossingCTO,retrogradePTA , orsnaring, antegrade PTA removedballoon (1) or sheath (2)andimmediate compression of the Pedal Puncture Site.

AngiographyandPTA (Potential)of Puncture Site.

Time of Transpedalaccess As short as possible!!! with duplex-sonographic orangiographic guidance 32. 0.014 (Miracle 12 Asahi ) wire +OTW ( Rujin , Terumo )Balloon 1.5/15 mm of Tibio - PeronealTrunk and Popliteal artery and SFAvia Transpedalapproach SheathlessApproach : 33. (4Fr Merit) -0.035- Stiff - 260wire Terumo 34. 35. , 3 Smart ( Cordis ) -6 .0-7.0 -150mm . - 36. Taxus 4.0/24mm , Final Kissing Balloon Dilatation Kissing 3.0/33mm ATA, 3.5 /28mm TPT 37. : 38. : 39. Pos-op Full Metallic Jacket 12 ~ 50 % !!! - !!! SFA and Popliteal arteries -? ? Pre -op 40. :9. Iliac artery Proximal Femoral Arteries Rutherford4 Rutherford1 41. : 9. 42. (DEB 6/60mm,(COOK)) Pre-op Post-op : 9. 43. Double Kissing Balloon dilatation Final Results ISRoftibial arteries 9 . 44. Pre-op PTA2.5/18mm Post-op 45. ?

50. ( )

( 20 )

51. 52. . ., 52 . 53. - ., 52 . . 54. - ., 52 . . . 1 . 55. :

- , !!!

57. ? 58. - ., 67 , 59. - ., 67 , - 60. - ., 6 9, - 24. 61. 2 1.5 62. 2 TASC 2(2007 ) 63. :

( .. )

64. -65 87% ( ) -+ 5-15% & & & 100 % , , 65.

66. !!! 1. 2. :, 3. 67. !!! vs + !!! 68.

100 % , ,

Эндоваскулярная хирургия диабетической стопы:...

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