双侧腘动脉陷迫综合症.ppt

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1、双侧腘动脉陷迫综合症双侧腘动脉陷迫综合症腘动脉陷迫综合症腘动脉陷迫综合症n首次由首次由 T.P.Anderson Stuart，于，于1879报道报道n由腘窝结构的异常导致的压迫症状和缺血症由腘窝结构的异常导致的压迫症状和缺血症状状n无或缺乏动脉硬化的危险因素无或缺乏动脉硬化的危险因素 n早期诊断非常重要早期诊断非常重要临床情况临床情况n文献报道（文献报道（PubMed）n年轻人中的发病率年轻人中的发病率0.16-3.5%n超过超过 80%的患者年龄的患者年龄 50的，没有太多动脉硬化危险因的，没有太多动脉硬化危险因素的，局限性腘动脉病变患者，要考虑到本素的，局限性腘动脉病变患者，要考虑到本病

2、的可能病的可能Bilateral popliteal artery entrapmentYongjun Li,Yuexin Chen,Wu Weiwei,Xiaozhen Li*Changwei Liu,Heng GuanDept.of Vascular SurgeryDept.of Radiology PUMC HospitalPopliteal Artery Entrapment SyndromenPopliteal entrapment was first described by a Scottish medical student,T.P.Anderson Stuart,in 187

3、9nCrush syndrome resulting from compression of the popliteal artery and impairment of its blood flow by structures of the popliteal spacenNon/less atheromatous causes of limb ischaemia nEarly diagnosis is important EpidemiologynLiteratures review from PubMedn0.16-3.5%prevalence in general young gene

4、rationnMore than 80%30,athletes,military personnelnMales 8:1 Females,25%bilateralnOne single center,3 years experiences(Jau/2006Dec/2008)*n9 diagnosed PAES in total 72 acute/chronic limb ischemia,under 45 years oldnPrevalence:12.5%;average age:23.89.4,77.8%less than 30;Males 7:2 Females,1 was bilate

5、ral*Wu Weiwei,Liu Changwei,et al,unpublished dataXXX56 years oldNo history of hypertension,diabetes,and cardiac ischemic disease,however,he was a smokerIntermittent claudication for 2 months,both sides Normal PositionNormal PositionPlanter flexionPlanter flexionDorsiflexionDorsiflexionABIABIABIABIAB

6、IABIRightRight0.880.880.590.590.760.76LeftLeft1.101.100.950.951.001.00Special ExaminationArteryVeinNerveInner head of GRight leg,Type IIRight leg,Type IILeft leg,Type IIIArteryNerveVeinConclusionTHANK YOU!THANK YOU!nPopliteal artery entrapment might be more popular than we are imaginativenEarly diag

7、nosis and Liberate compression syndromesnBe considered in patients over 50 with local popliteal artery stenosis(less cardiovascular risk factors)Backup information序号序号方位方位治疗次数治疗次数取栓取栓手术切手术切口口补片成补片成形形血管旁路血管旁路插管溶栓插管溶栓肌肉肌肉松解松解术后用药术后用药随访结果（时随访结果（时间）间）1L第1次是小腿内侧静脉补片否否否华法林术后1月闭塞第2次是腘窝后方静脉补片否否腓肠肌内侧头切断华法林通畅

8、（23月）2L第1次否小腿内侧否BKIS否否华法林通畅（34月）3R第1次是腘窝后方静脉补片否否腓肠肌内侧头切断华法林术后20月闭塞第2次是小腿内侧否否否否华法林通畅（2月）4R第1次是腘窝后方静脉补片否否腓 肠 肌 内 侧头切断华法林通畅（18月）5L第1次是腘窝后方人工补片否否异 常 肌 束 切断华法林通畅（18月）R第1次是腘窝后方人工补片否否腓肠肌内侧头切断华法林通畅（18月）6R第1次否否否否r-tPA否肝素叶酸1周后手术第2次否腘窝后方否否否腓肠肌内侧头切断华法林叶酸通畅（11月）7L第1次否小腿内侧否BKIS否否华法林通畅（11月）8R第1次是腘窝后方人工补片否否异 常 肌 束 切断华法林通畅（8月）9R第1次否否否否否华法林PredCTX闭塞（6月）第2次否否否否否肝素1天后手术第3次否腘窝后方否否否腓肠肌内侧头切断华法林Pred通畅（1月）