Interventional therapy is a new method between surgical and medical treatment, including intravascular intervention and non vascular intervention. After decades of development, it has been called three pillar disciplines together with surgery and internal medicine. The concept of interventional therapy refers to a technology of minimally invasive diagnosis and treatment of diseases by percutaneous puncture under the guidance of imaging equipment (angiography machine, fluoroscopy machine, CT, Mr, B ultrasound, etc.), using puncture needle, catheter, stent and other devices.
A major branch of interventional therapy is peripheral vascular intervention, which refers to the technology of diagnosis or treatment of other blood vessels except intracranial blood vessels and cardiac coronary blood vessels through vascular puncture under the guidance of medical imaging equipment, excluding the technology of diagnosis or treatment of tumor diseases through vascular pathway.
Peripheral vascular diseases, known as vascular diseases in traditional Chinese medicine. The incidence rate has increased significantly in recent years, such as arterial stenosis, arteriovenous thrombosis, aneurysm and so on. Peripheral artery stenosis and occlusive disease, common in atherosclerosis, diabetes, arteritis and so on, mainly manifested as skin temperature reduction, muscle atrophy, pulse can not be touched or weakened, intermittent claudication, severe distal limb necrosis, even amputation, severe life-threatening; Venous thrombotic diseases can cause blood stasis and swelling of the affected limb, and at the same time have the risk of fatal pulmonary embolism; aneurysmal diseases have the risk of rupture, bleeding and death at any time.
Peripheral vascular disease has a high disability rate and a certain mortality rate, medical treatment effect is very little, surgical treatment is invasive treatment, and the effect is limited. In 1964, American doctors D. Yuba and ludkil. Created a non-surgical method for the treatment of peripheral vascular diseases. In 1972, gnuntzig invented the double lumen balloon catheter, which made the technology mature. Since then, we have developed laser angioplasty, dynamic angioplasty (rotating catheter), intravascular stent, ultrasound angioplasty, gene therapy and intravascular radiotherapy to prevent restenosis. With the continuous progress of the treatment methods, the indications are expanding, and the treatment effect is obviously improved. The equipment will be compounded, biologized and medicated, and the operation will be simplified. At present, balloon catheter and intravascular stent are still the main treatment. In the future, intravascular radiotherapy and gene therapy may be the focus of the development of prevention of restenosis. Therefore, more and more peripheral vascular diseases can be treated by percutaneous vascular intervention, and its advantages are irreplaceable by drugs and surgery.
At present, the interventional therapy of peripheral vascular diseases is widely used in clinical practice. Interventional therapy is simple and safe, minimally invasive, less complications, accurate location, repeatability and other advantages. The interventional treatment of peripheral vascular diseases has developed from the original limb artery to the great artery and vein, and even almost all the blood vessels in the whole body. At present, the most successful interventional treatment is iliac, femoral, renal and inferior vena cava stenosis. The scope of interventional therapy is mainly three kinds of diseases: vascular stenosis or occlusion, vascular dilatation and vascular malformation.
At present, the main methods of interventional therapy for peripheral vascular diseases are balloon angioplasty and stent placement. The best indications of balloon angioplasty are medium size or large vessel limitation, isolated short segment stenosis, followed by multiple, scattered short segment stenosis and occlusion. Long-term stenosis or occlusion, small vessel disease, ulcerative stenosis or calcified stenosis or occlusion are not suitable for PTA treatment. On the basis of balloon angioplasty, stent is placed in the diseased segment to support the blood vessels in the stenosis and occlusion segment, reduce the elastic retraction and remodeling of blood vessels, and keep the blood flow unobstructed. Some internal stents also have the function of preventing restenosis. In addition, interventional catheter thrombectomy and contact thrombolysis with indwelling catheter are feasible for the treatment of arteriovenous thrombosis. Compared with surgery, it has less risk, fewer complications, strong patient tolerance and better effect than medicine. In the treatment of aneurysms, stent graft was used to insulate the aneurysms for local endovascular angioplasty, which could keep the vascular lumen unobstructed and greatly reduce the risk of rupture and bleeding of aneurysms.
With the continuous development of interventional radiology, peripheral vascular intervention has gone through the process from percutaneous transluminal angioplasty (PTA) to the development of dynamic angioplasty, laser angioplasty and intravascular stent, and achieved good results; since the 1990s, in order to effectively prevent restenosis (restenosis rate 30%), gene therapy and The research and application of intravascular radiotherapy have achieved some results, and will continue to be studied in the 21st century.
It can be predicted that with the continuous progress of interventional equipment and new technology, the continuous expansion of the scope of intervention, and the continuous improvement of interventional treatment methods, peripheral vascular intervention will play an increasingly important role in clinical treatment.