外周血管支架的手术

阳光早餐

1、 自动扩张支架
　　a、根据靶血管的部位选择穿刺插管途径，穿刺后引入导管鞘。
　　b、插入球囊导管对血管狭窄部位先行胶囊扩张成形，以便支架顺利抵达靶部位，然后更换内径略大于支架直径的导引导管至病变部位。
　　c、经导管用导丝将支架放置器推送至血管狭窄部位，撤去外鞘，支架即自扩张，恢复原形并支撑在血管内。
　　d、再用球囊导管进行扩张，使金属丝嵌于斑块组织内，以增加血管内腔的光滑度。
　　e、造影观察支架放入位置及扩张效果。

2、 球囊扩张支架
　　a、 穿刺插管。
　　b、对血管狭窄部位进行胶囊扩张，而后插入导丝，退出球囊导管。
　　c、沿导丝引入支架-球囊导管，并置支架于血管狭窄部位。
　　d、加压充盈球囊，使支架扩张并支撑在血管狭窄部位。
　　e、再换直径略大的球囊导管对支架进行再次扩张，使其稳定置入狭窄部位并保持血管内壁光滑。
　　f、造影观察支架支撑位置及成形效果。

3、热记忆支架 略
　　非血管内支架手术过程（食道）：
　　1、 自动扩张支架
　　a、 患者采用仰卧位或侧卧位。根据X光片或钡餐进行体表定位。
　　b、 让患者咽下造影管或导尿管过咽喉部，当送导丝通过狭窄段时，退出造影管或导尿管。
　　c、 沿泰尔茂导丝送入球囊导管进行预扩张。扩张完毕后，退出球囊导管。（可用可不用此步骤）
　　d、 经导丝将支架放置器推送至狭窄部位，撤去外鞘，支架即自动扩张，恢复原形并支撑在食道管腔内。
　　e、 退出输送器后，再用球囊导管进行扩张，使支架达到一定的直径。

　　f、观察支架放入位置及扩张效果。
　　2、球囊扩张支架 不适合用于食道。
　

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