Год назад я писал про новые отечественные рекомендации
Цитата:
Сообщение от mizin1
Я бы хотел поделиться своими первыми положительными впечатлениями от чтения рекомендаций по лечению заболеваний артерий н/к........
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В последние месяцы SCAI опубликовало 3 консенсуса об эндоваскулярном лечении артерий н/к на трех уровнях по очереди: аортоподвздошый сегмент, бедренно-подколенный сегмент и ниже колена. Это интересное событие достойное небольшого анализа. Во-первых, это, получается, последний документ авторитетного сообщества, который мы должны учитывать в своей работе. Во-вторых, интересно сравнить, год назад казалось, что наши рекомендации очень хороши.
Тезисно по американским консенсусам (я пропускал очевидные бесспорные положения).
Аорто-подвздошный сегмент.
- For Type “D” lesions, surgical bypass is the preferred treatment modality for revascularization. However, with improved operator techniques and newer re-entry devices/catheters, experienced endovascular specialists are able to approach TASC C and D lesions with an endovascular strategy. Hybrid surgical-endovascular approaches have also been developed for patients with aorto-iliac and lower extremity occlusive disease.....Operator
and institutional expertise should also be considered in the treatment algorithm, particularly for patients with extensive and complex aorto-iliac disease (TASC C and D lesions).......Overall, aorto-iliac occlusive disease is more commonly being treated with an endovascularfirst approach, using open surgery as a secondary option.
- Occasionally, intervention is necessary in asymptomatic patients to facilitate delivery of large sheaths (endovascular aneurysm repair, transcatheter aortic valve replacement), hemodynamic support devices, or to facilitate percutaneous coronary intervention.
- Appropriate care - Internal iliac artery (IIA) with moderate to severe symptoms of buttock or hip claudication or major tissue loss (RC 2–6) with >50% stenosis and/or resting mean translesional gradient >5 mmHg.
- May be appropriate care - IIA >50% stenosis with vasculogenic impotence.
- The preferred site for arterial access depends on several factors including: ……… 7) availability (доступность, пригодность) of radial or brachial artery access.
- Initial arterial access via the radial artery or brachial artery is also an attractive option for some patients, but lesion location and equipment length should be taken into account during treatment
planning.
- Primary stent placement may minimize vessel recoil and prevent abrupt occlusion, but there is debate over the relative benefit of primary stenting vs. provisional stenting for reducing restenosis in this vascular territory. The current 2011 ACC/AHA guideline document supports
primary stenting of the common and external iliac arteries with a Class I recommendation (Level of Evidence B).
- Either balloon expandable or self-expanding stents can be used for the treatment of aorto-iliac lesions. Overall, no clinically available stent has been demonstrated as superior to any other in the aorto-iliac distribution.
- One option is to perform a hybrid procedure with open femoral endarterectomy (with or without profundoplasty) followed iliac stenting.
- Following aorto-iliac intervention, it is important to perform a post intervention arterial run-off angiogram to rule out DE. DE has been reported in most studies of iliac interventions; the incidence ranges from 0.4 to 9%.
- Pain during balloon inflation is a warning sign of impending rupture. Perforations can be stabilized with immediate balloon inflation proximal to the tear to tamponade the bleeding.
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