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1 Vascular Diseases 血管外科疾病 ZHAO JICHUN ( 赵纪春 ) M.D. & Ph. D. Vascular Surgery, West China Hospital, Sichuan University

2 Part I Content The overview of vascular disease 血管外科疾病总论 Symptoms and signs 症状和体征 Part II Common vascular diseases (artery and vein disease) 血管外科常见疾病

3 Part I The overview of vascular disease Symptoms and signs 血管外科疾病概述

4 Introduction Arterial and venous circulation Vascular : cardiovascular cerebrovascular(intracranial) peripheral vascular

5 Introduction Peripheral vascular diseases: comprise disorders of the arteries and veins, but exclude cardiovascular and cerebrovascular. 除心血管及脑血管系统之外的所有循环系统疾病

6 6 Classification Characteristics 分类 Shape Arterial disease Stenosis 狭窄 Venous disease Occlusion 闭塞 Dilation 扩张 Mixed disease Rupture 破裂

7 Arterial Disease: Aneurysm( 动脉瘤 ) Stenosis( 动脉狭窄 ) Occlusion( 动脉闭塞 ) Rupture( 动脉瘤破裂 ) Venous Disease: Varicose vein( 静脉曲张 ) Venous thrombosis( 静脉血栓形成 ) Mixed Disease Arteriovenous fistula( 动静脉瘘 )

9 Abdominal aortic aneurysm,aaa 腹主动脉瘤

10 Internal Carotid aneurysm 颈内动脉瘤

11 历史沿革年, 年, 加拿大美国等国的基督教会在成都创办仁济存仁医院 Renal artery stenosis Page 11

12 Aortoiliac Occlusion 主髂动脉闭塞

13 Varicose Vein 静脉曲张

14 1 4 Acute Deep Venous Thrombosis(DVT) 深静脉血栓形成

15 Clinical manifestation 临床表现 Heart Congestion vein artery ischemia Organs and tissues

16 N O 1 6 ARTERY: Arterial blood carry oxygen and nutritional materials from heart to organs or tissues of the whole body. Arterial stenosis and occlusion will cause ischaemia of organ and tissue, which will present the symptoms and signs of arterial insufficiency, such as lower limb ischaemia.

18 N O 1 8 VEIN: Transfer metabolic products from organs and tissues to heart and evacuate them via lung and kidney. The blood flow in vein is on one direction forward heart which depend on: 1 muscle contraction ( 肌肉收缩力 ) 2 negative pressure during inhaling of lung and diastole of heart ( 心肺的抽吸作用 ) 3 vein valves( 静脉瓣 )

19 Clinical manifestation 临床表现 Sensation 感觉 Color 颜色 Shape 形态 Nutrition 营养性变化

20 Pain 疼痛 Sensation abnormality 感觉异常 Intermittent pain 间歇性疼痛 1.Intermittent claudication 间歇性跛行 2.Position pain 体位性疼痛 3.Temperature pain 温度性疼痛

21 Position pain 体位性疼痛 Limb Limb relieve easy Heart difficult aggravate Congestion 肿胀 vein artery Ischemia 缺血 Organs and tissues

22 Temperature pain 温度性疼痛 Warm Cold Expand vessel 血管扩张 Contract vessel 血管收缩 Ischemia 缺血 Congesti on 肿胀

23 Sensation abnormality 感觉异常 Pain Persistent pain(rest pain):ischemia,inflammation,necrosis 持续性疼痛 ( 静息痛 ): 缺血, 炎症, 坏死 1.Artery rest pain 2. Vein rest pain

24 Sensation abnormality 感觉异常 Skin temperature 皮肤温度 Artery stenosis or occlusion : decreased Vein occlusion: increased Numbness and paralysis 麻木和麻痹 Early stage( 早期 ): numbness 麻木 Later stage( 晚期 ): paralysis 麻痹

25 Color abnormality 皮肤颜色异常 Arterial disease 动脉疾病 Venous disease 静脉疾病 Color Pallor 苍白 Flare 红肿 Pressure test Delayed return of capillary blush Exercise test Pallor + Flare + Position test Elevate: pallor + Drop back induce return +:aggravate Elevate: Flare - -: relieve

26 Shape abnormality 形态异常 Atrophy 萎缩 : arterial occlusion Swollen 肿胀 : venous disease Abnormal growth 生长异常 : venous disease Local nodule 局部结节 :varicose veins

27 Construction abnormality 营养性障碍 Necrosis or gangrene 坏死或坏疽 : arterial ischemia Ulcer 溃疡 : venous disease

28 Others manifestation Pulselessness 无脉 : arterial occlusion Femoral A Dorsalis pedis A posterior tibial A Popliteal A Pulse: absent, decreased, or normal--comparing a pulse with that in the contralateral extremity can demonstrate changes indicative of proximal stenosis or occlusion

29 Others manifestation Pulsating mass: arterial aneurysm 搏动性包块 : 动脉瘤 Murmur or tremor: A-V fistula 震颤 : 动静脉瘘 artery vein

30 N O 3 0 VEIN Stenosis 狭窄 Obstruction 闭塞 Valve function insufficiency 静脉瓣膜功能不全 varicose vein swelling stagnation Ischaemia

31 Clinical Manifestation ARTERY? VEIN? Acute? or Chronic?

32 HISTORY IN PATIENTS WITH ARTERIAL DISEASE acute arterial occlusion 急性动脉闭塞 6 P s sign 6P 征 : pain 疼痛 Paresthesias 感觉异常 Paralysis 麻痹 poikilothermy (change with temperature, cool extremity) 变温性 Pallor 苍白 Pulselessness 无脉 chronic arterial insufficiency 慢性动脉缺血 chronic or long-standing symptoms and encompasses a spectrum of symptoms, beginning with effort discomfort (claudication) and progressing to pain at rest and tissue loss. ( 间歇性跛行静息痛 )

33 HISTORY IN PATIENTS WITH VENOUS DISEAS acute venous thrombosis 急性静脉血栓形成 chronic venous occlusion or valvular incompetence with venous reflux 慢性静脉闭塞 / 静脉功能不全 pain or discomfort and swelling of the extremity ( 疼痛, 不适或肢体肿胀 ) venous hypertension and edema( 静脉性高压及静脉水肿 ) venous stasis ulcers( 静脉性溃疡 )

34 Part II Common vascular diseases (artery and vein disease) 血管外科常见疾病

35 N O 3 5 Thromboangiitis Obliterans (Buerger s Disease) 血栓闭塞性脉管炎

36 N O 3 6 Pathogenesis 1 The definitive etiology : At present unknown Smoking plays a crucial role. 吸烟是主要诱因 60-95% have the history of smoking 60-95% 吸烟史

37 Pathogenesis 2 It has been suggested: Buerger s disease is an autoimmune disorder( 自身免疫性疾病 ) The autoimmune response may cause dysfunction of the endothelial cells with increased propensity to thrombosis and vasoconstriction ( 免疫反应导致内膜损伤血栓形成 / 血管痉挛 )

38 Main Pathology Buerger s disease is an inflammatory nonatherosclerotic disease of the small to medium-sized arteries and veins 炎性反应主要累及中小血管 NO38

39 N O 3 9 Clinical manifestation Clinical picture is dominated by signs of skin ischemia ranging from Raynaud s phenomenon ( 雷诺现象 ) to signs of local critical ischemia and eventual gangrene.

40 N O 4 0

41 Symptoms and signs Including: young man(aged:18-50),heavy smoker 青年男性吸烟史 1 Pain: most at fingers or toes 肢端疼痛 2 Abnormality in colour and temperature 皮肤颜色及温度异常 3 Migratory superficial phlebitis 游走性浅静脉炎 4 Pulselessness 无脉 5 Ulcer and gangrene 溃疡和坏疽

42 吸烟 Smoking Inflammatory Young men 青年男性 disease medium to small size 炎症反应累及中小血管 Arteries Veins Skin Muscle Phlebitis migrans 浅静脉炎 Raynauds s attacks 雷诺现象 Ulcers 溃疡 Gangrene 坏疽 Claudication 间歇性跛行 Infection 感染 Figure 7-11 Schematic representation of symptoms and signs in Buerger s disease

43 N O 4 3 Clinical Stages 临床分期 : Stage1:Intermittent claudication 间歇性跛行 Stage2:Persistent Pain(rest pain) 静息痛 Stage3:Ulcer and gangrene 溃疡和坏疽

44 N O 4 4

46 Physical examination: Skin Temperature, Sensation, Pulse of artery Special examination: 1 Dopplor Ultrasound: blood flow, patency and lesion site 2 Noninvasive examination: Blood pressure, ABI 3 Arteriography

47 图 1 左侧股浅动脉下段图 2 左侧股浅动脉下段图 3 右侧胫前动脉频谱图 4 右侧足背动脉频谱

48 N O 4 8 Femoral artery occluded

49 Differential Diagnosis 鉴别诊断 1 Atherosclerosis occlusion( ASO) 动脉粥样硬化闭塞 : older age(>50 years old) 老年患者 hyperlipidemia 高脂血症 hypercholesterolemia 高胆固醇血症 hypertension 高血压 diabetes 糖尿病 2 Embolic occlusive disease 动脉栓塞 (Five P signs 5P 征 : Pain, Pallor, Pulselessness, Paraesthesia, Paralysis)

50 N O 5 0 Aortoiliac Occlusion 主髂动脉闭塞

51 N O 5 1

52 N O 5 2 Femoral artery occluded 股动脉闭塞

53 Alpha blocking agents a 受体阻断剂 Stop Smoking Cure local infection Calcium Relief of Amputation antagonists ischemia 截肢钙离子拮抗剂 Iloprost Bypass 前列素类药物 Sympathectomy surgery Figure 7-14 Principles of treatment of Buerger s disease 血栓闭塞性脉管炎的治疗原则

54 N O 5 4 Surgery (1) Sympathectomy ( 交感神经切除术 ): Stage 1 or 2. Lumbar sympathetic ganglionectomy and trunk resection which based on the evidence that the skin and muscle vessels and the collaterals were supplied by sympathetic vasoconstrictor nerves (2) Bypass surgery( 搭桥手术 ): Stage 2 or 3

55 N O 5 5 Femoropopliteal Bypass 股动脉 - 膝上膕动脉搭桥 Infrapopliteal Bypass 膝上 - 膝下膕动脉搭桥

56 N O 5 6 Femoropopliteal Bypass

57 N O 5 7 Arterial anastomosis

58 N O 5 8 In Situ Saphenous Vein Arterial Bypass

59 Endovascular Therapy Percutaneous Transluminal Angioplasty, (PTA) 经皮腔内血管成形术 Balloon and Stent Placement 球囊扩张和支架置入 NO59

60 N O 6 0

61 N O 6 1

62 N O 6 2

63 N O 6 3

64 N O 6 4

65 N O 6 5

66 N O 6 6

67 Abdominal Aortic Aneurysm 腹主动脉瘤

69 Albert Einstein 死于腹主动脉瘤一种血管扩张性疾病

70 Abdominal Aortic Aneurysm (AAA) 腹主动脉瘤 Definition: Aneurysms are defined as focal dilatations at least 50% larger than the expected normal arterial diameter 腹主动脉局限性异常扩张, 与正常血管相比, 局部血管直径永久性增大超过 1.5 倍 1 正常主动脉腹主动脉瘤

71 A practical working definition: Abdominal Aortic Aneurysm > 3 cm Common Iliac Aneurysm> 1.8 cm 腹主动脉的直径超过 3cm, 可以诊断为腹主动脉瘤髂总动脉的直径超过 1.8cm, 可以诊断为髂总动脉瘤 The Normal Aortic Diameter gradually decreases Thorax (28 mm in men) Infrarenal location (20 mm in men). Women<man 2mm 男性主动脉直径在各个层面比女性大 2mm

72 Nearly all AAAs involve the infrarenal aorta, Only about 5% to 15% of AAAs undergoing surgical repair also involve the suprarenal aorta 绝大部分腹主动脉瘤为肾动脉下型 Rupture! 腹主动脉瘤未能得到及时诊断和治疗, 就有可能发生破裂死亡

Epidemology Of AAAs Incidence of AAAs of the Wolrd: 3-117 / 100,000/yrs 60 岁以上男性 AAA 发病率 : 4-8% 人口老龄化 AAAs 的发病率美国就有约 200 万名 AAA 患者, 每年的新发病人在 20 万例以上

73 Epidemology Of AAAs Incidence of AAAs of the Wolrd: / 100,000/yrs 60 岁以上男性 AAA 发病率 : 4-8% 人口老龄化 AAAs 的发病率美国就有约 200 万名 AAA 患者, 每年的新发病人在 20 万例以上 RAAAs:15th leading cause of death overall 10th leading cause of death in men older than 55y 大多数 AAAS 没有临床症状, 难以发现和及时就诊无声的杀手美国一年有大约 15,000 名患者死于 AAAs, 死亡率和艾滋病相当

Incidence of Rupture(AAAs) Evaluation of Risk for Rupture(Annual) 破裂风险的评估 ( 每年 ) 4.0-5.4 cm 0.6% 5.5-6.4 cm 10% 6.5-6.9 cm 19% 7.0-7.

74 Incidence of Rupture(AAAs) Evaluation of Risk for Rupture(Annual) 破裂风险的评估 ( 每年 ) cm 0.6% cm 10% cm 19% cm 35% 8.0 cm 51% Evaluation of Increasing Speed(Annual) 瘤体增大速度的评估 ( 每年 ) < 4 cm cm 4-5 cm cm > 5 cm cm 破裂风险瘤体增大速度动脉瘤直径

75 Early Diagnosis and Treatment for AAAs 82% of RAAAs Die Motality of RAAA after arriving hospital: 50% 破裂腹主动脉瘤患者被送到医院 : 死亡率为 50% Motality of RAAAs for operation:30-70% 破裂腹主动脉瘤的手术死亡率 :30-70% Motality of AAAs for Elective Surgery: 2-7% 腹主动脉瘤的择期手术死亡率仅为 2-7% AAA can be detected by Ultrasound

76 Old Age > 65y Male Risk Factors for AAAs 腹主动脉瘤的危险因素 Family History 一级男性亲属 : 20% Past History 既往史 Aneurysm Atherosclerosis 筛查患者的一级男性亲属! Hypertension COPD 筛查患有动脉粥样硬化的吸烟老年男性 Infection/Inflammation Smoking

77 Symptoms: Diagnosis for AAAs Most of AAAs are Asymptomatic 多数腹主动脉瘤患者没有症状通常因慢性后背疼痛或肾结石行 CT 或超声检查而偶然发现 Symptomatic AAAs shows possibility of rupture 有症状的腹主动脉瘤 ( 后背 - 胁部 - 腹部疼痛 ) 提示近期破裂可能

78 Diagnosis for AAAs Physical Examination: Pulsatile Mass 腹正中搏动性包块 Continuous Vascular Murmur : Aortic-Vena Cava Fistula 闻及持续性血管杂音提示主动脉腔静脉漏 Sensibility and Specificity: Low 敏感性和特异性低 :80% 漏诊

79 Ultrasound: Most effective for diagnosis 超声筛查能够避免 70% AAA 破裂导致的死亡 Advantages of Ultrasound: Sensibility and Specificity: High 敏感性高 : 82-99% Noninvasive Cheap AAA Deaths 岁男性 AAA 筛查研究 Screened group (n = 2,212) 21 Control group (n = 3,058) Years Since Entry

80 Further Diagnosis for AAAs CTA:Golden Standard Advantage: 薄层扫描 3mm 快速 :15-30 秒, 单次屏气空间分辨率高, 精确可以进行三维重建受操作医师 / 技师判断影响小 Disadvantages: Radiation Exposure; Contrast nephropathy MRA DSA 用于动脉瘤长度的测量, 无法测量动脉瘤的直径, 不能替代 CT 或者 MRI

81 Principle for Treatment of AAAs» 国际上遵循以下原则 Diameter of AAA <4cm 4cm~5cm >5cm Symptomatic Annual Growth Rate>1cm Principle Follow up every year Follow up every 6 months Open Surgery or EVER

82 Treatment of AAAs 血管腔内修复术 (EVAR) 开腹手术 (Open Surgery)

83 Advantages: Open Surgery 1 st Open Surgery(1951 Dubost) 50 years of clincal experience Long-term Effect: Good! Disadvantages: Huge Incision 30 90min for clamping Time for Surgery: Long Slow Recovery ICU 1 2d 住院 7 14d 完全恢复 4 6w

既往腹部手术史 Complication: Pseduoaneurysm 假性动脉瘤 (3%) Sexual Dysfunction 性功能障碍

84 Contraindication: Open Surgery High Risk of Anesthesia 麻醉风险高 Cardiac/Respiratory Dysfunction 心肺功能异常 Past Surgical History of Abdomen 既往腹部手术史 Complication: Pseduoaneurysm 假性动脉瘤 (3%) Sexual Dysfunction 性功能障碍 (25%) Aortoenteric Fistula 主动脉肠瘘 (1-2%) Graft Thrombosis 移植物血栓形成 (2%) Graft Infection 移植物感染 (1-2%)

87 Advantages: 腹主动脉瘤腔内修复治疗 (EVAR) Minimal Invasive 微创 Femoral Artery Approach 股动脉入路, 无需开腹 Low Mortality 死亡率低 Short Time for Surgey 手术时间短

88 Advantages: 腹主动脉瘤腔内修复治疗 (EVAR) Quick Recovery 术后恢复快 No ICU Length of Hospital Stay: Decrease Quality of Life: High 术后生活质量高 Pain Incidence of paralysis Sexual Dysfunction

89 Stent for AAAs 肾上锚定通用型接口镍钛合金材料 : 可行 MRI 检查 + 牢固可靠的聚酯覆膜中间的 C-bar 结构兼具支撑力和柔韧性外倾和逐渐变细的支架延长段

90 腹主动脉瘤腔内修复治疗 ( Endovascular Repair for AAA)

91 腔内修复治疗 (EVAR) Anatomy Condition 解剖条件合适 Vacular Access 血管通路 Length and Tortuosity of Neck 主动脉瘤颈长度和扭曲程度 Calcification of Vessels 血管钙化 Accurate Calculation 测量精确 3mm CT 薄层扫描 Devices 良好的显影成像设备 Follow up 强烈建议患者术后每年随访复查

92 Comparision of EVAR and Open Surgery 随机对照研究证实 EVAR 相对于开放手术的优越性 TRIAL EVAR OPEN P 值 EVAR I (#)* 天死亡率 1.7 % 4.7 % 0.04 二次干预 6.9 % 2.4 % < DREAM (#)** 天死亡率 1.2 % 4.6 % 0.1 手术死亡率和严重并发症 4.7 % 9.8 % 0.1 Note: * Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomized controlled trial Lancet Vol 365 June 25, 2005 **A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms the NEJM Vol 351 Oct. 14, 2004

93 Preoperative Evaluation CTA

95 N O 9 5 PRIMARY VARICOSE VEIN OF LOWER EXTREMITY 下肢静脉曲张

97 N O 9 7 Introduction Varicose veins are dilated, tortuous and prominent superficial veins in the lower limb 下肢浅表静脉的迂曲, 扩张 2% of the population has varicose vein, the incidence of varicose vein increase with age

98 1.Anatomy and physiology Long saphenous vein 大隐静脉 Supe rficia l Veins Tributaries sapheno-femoral junction-femoral vein, no artery accompanied and muscle support Short saphenous vein 小隐静脉 popliteal vein

99 N O 9 9

100 N O Deep Veins 深静脉 : anterior tibial vein posterior tibial vein popliteal vein Superficial femoral vein Deep femoral vein common femoral vein common iliac vein inferior vena cava

101 N O Communicating vein 交通静脉 4. Valve 静脉瓣

102 N O Dynamics: The blood flow in vein is on one direction forward heart which depend on: 1 muscle contraction 肌肉收缩力 2 negative pressure during inhaling of lung and diastole of heart 心肺抽吸作用 3vein valves prevent retrograde flow of blood in a proximal-to-distal direction 静脉瓣防止倒流

103 Cause of disease Genetic factor 遗传因素 Acquired factor: increased vein gravity 静脉压力增加 long standing work 长期站立 heavy physical labor 负重 Pregnacy 怀孕 NO103

104 N O 1 0 4

105 Clinical manifestation 临床表现 Early stage( 早期 ): Vein dilated and tortuous 静脉迂曲, 扩张 Middle stage( 中期 ): Swollen, itch 下肢肿胀, 皮肤瘙痒 Late stage( 晚期 ): Pigementation,Ulcer 皮肤色素沉着, 皮肤溃疡 NO105

106 N O Ulcer Development: (a)pressure and stasis (b)arteriovenous shunts (c)the fibrin diffusion block (d)white cell trapping and activation

107 Physical Examination 1The Trendlenburg Test 大隐静脉瓣膜功能试验 To assess the direction of blood flow and the refilling of the superficial veins 2 Perthes Test 深静脉通畅试验 To assess if the deep vein were competent and unobstructed

108 N O 1 0 8

109 N O 1 0 9

110 N O 1 1 0

111 N O Differential Diagnosis 鉴别诊断 1.Chronic venous insufficiency 慢性静脉功能不全 2.Congenital venous abnormality 先天性静脉畸形 3.Post-thrombotic syndrome 深静脉血栓后遗症 4. Ateriovenous fistulae 动静脉瘘

112 NO112

113 N O TREATMENT Main objectives 1.Satisfactory cosmesis 2.Relief of symptoms 3.Treatment of complications 美容效果减轻症状治疗并发症 4.Prevention of complications 预防并发症 5.Prevention of recurrence 防止复发

114 General treatment External elastic compression: 静脉弹力袜 support stockings: relieving symptoms Sclerotherapy: 硬化剂注射 obliteration of varicose veins and connections between the superficial and deep veins NO114

115 N O 1 1 5

116 Surgical treatment of varicose veins 1.High ligation and division of the long saphenous vein and its tributaries at the sapheno-femoral junction 大隐静脉高位结扎 2.Stripping the long saphenous vein 大隐静脉剥离 3.Avulsion,ligation or excision of varicose vein 曲张静脉剥脱术 NO116

117 N O 1 1 7

118 N O 1 1 8

119 N O 1 1 9

120 Deep Venous Thrombosis 下肢深静脉血栓形成

121 Introduction Deep Venous Thrombosis(DVT) is a blood clot that forms in a vein deep in the body. 静脉血栓是多种原因导致人体静脉血管内血栓形成的疾病, 被视为第三大常见血管疾病 Most deep vein clots occur in the lower leg or thigh 最常见的静脉血栓是下肢深静脉血栓 Incidence of DVT(Annual):1.45/1000

122

123 Risk Factors for DVT 深静脉血栓形成的危险因素 1.Vessels Injury 各种原因引起血管壁损伤 2.Abnormality of Blood Flow 血流异常 ( 如血流缓慢或淤积 ) 3.Hypercoagulative State 血液成份改变 ( 如高凝状态 )

124 Epidemiology of DVT Incidence for inpatient in 1 week: 15% in 2-12 weeks: 9%-94% Incidence for post general surgery: 19% Incidence for post orthopaedic procedures:40-60% Incidence of DVT for Pregnancy

125 Clinical Manifestation Pain 疼痛 Flares 皮肤暗红 Swelling 肿胀 Increased Skin Temperature 皮温增高 Dilation and Tortuous of Superfical Vein 浅静脉迂曲

126 Complication for DVT Pulmonary Embolism(PE): 最严重的并发症 Critical PE(more than 50% of pulmonary circulation) Cardiac and Respiratory Failure Symptomatic PE Asymptomatic PE Short of Breath Pulmonary Artery Hypertension

127 Complication for DVT Phlegmasia Cerulea Dolens(Blue Legs): 股青肿静脉血栓早期时严重的肢体肿胀肢体张力极度增高肢体动脉受压和痉挛缺血坏死

128

129

130 Examination for DVT Ultrasound/ Venography: 了解血栓部位及范围对侧肢体有无血栓 CTA: 怀疑有肺动脉栓塞 (Pulmonary Embolism, PE)

131 Initial Treatment of DVT Mobilization and Leg Elevation Anticoagulation: 普通肝素 1000 U/h 静脉泵入低分子肝素 0.4ml q12h ih 4~7 天 + 华法林 2.5mg qd INR: 口服华法令 : 3~6 月发病危险因素不明确 / 长期存在 DVT: 口服华法令 1 年甚至终生 Thrombolysis 溶栓 : 尿激酶或重组链激酶 50 万 U/ 天静脉泵入 5~7 天根据凝血机制监测结果及临床表现的变化调整用量

132 Initial Prevention of Pulmonary Embolism Indication for Vena Cava Filters: Repeated PE 反复发生肺栓塞 Float Thrombus 存在悬浮游离的血栓 Contraindications to anticoagulation 抗凝禁忌 Blue Leg/ Venous Thrombectomy 股青肿患者行手术取栓

133

134

135

136

137 Prevention and Treatment of Post- Thrombus Syndrome 静脉血栓后期静脉瓣膜破坏静脉功能不全继发性静脉曲张 (20%~30%) 足靴区顽固性溃疡 (3%~5%) 色素沉着皮肤湿疹溃疡疼痛感染影响生活质量

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140 Post- Thrombus Syndrome 深静脉血栓后综合症

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142 Prevention and Treatment of Post- Thrombus Syndrome Anticoagulation: Warfarin 12 months INR: 2~2.5(2008 指南 ) Elastic Stockings: 坚持穿循序减压弹力袜 (2007 指南 ) 静脉活性药物 : 地奥斯明 ( 爱脉朗 )(2008 指南 )

143 Thanks 谢谢! 微信平台 : 华西血管

参会邀请函一大会组织结构尊敬的嘉宾您好第二届国际血管联盟中国大会 Chinese Chapter Congress of the International Union of Angiology CCC-IUA) 将于 2015 年 10 月 22-24 日在北

参会邀请函一大会组织结构尊敬的嘉宾您好第二届国际血管联盟中国大会 Chinese Chapter Congress of the International Union of Angiology CCC-IUA) 将于 2015 年 10 月 22-24 日在北 2015 国际血管联盟中国大会 (Chinese Chapter Congress of the International Union of Angiology, CCC-IUA) 第十一届中国首都血管学术论坛 (Chinese Capital Vascular Symposium, CCVS) 会议通知 ( 第二轮 ) 主办单位 : 北