下肢动脉解剖材料.ppt

* Inguinall, adductor, sartoris muscles are the boundaries * 收肌管 (adductor canal)又称Hunter管。位于股中1/3段前内侧，缝匠肌深面，大收肌和股内侧肌之间。由股内侧肌、缝匠肌、长收肌和大收肌围成。是一断面呈三角形，长15～17㎝的管状间隙。前壁为张于股内侧肌与大收肌间的收肌腱板，浅面覆以缝匠肌，外侧壁为股内侧肌，后壁为长收肌和大收肌。上口与股三角尖相通，下口为收肌腱裂孔，通腘窝上角。所以收肌管又称股腘管。 The femoropopliteal system is a low-flow, high-resistance vascular bed * 在下肢股浅动脉是动脉硬化狭窄性病变的最常见的发生部位，而在股深动脉却很少发生。股浅动脉斑块并不好于分支部位，而斑块引起的狭窄性病变最早出现的部位是收肌腱裂口处。靠近股浅动脉的大收肌腱的机械刺激使该处容易形成动脉硬化斑块导致股浅动脉下段发生闭塞。但是也有学者持不同看法。Blair认为内收肌管内的股浅动脉并不十分易于形成硬化斑块，而是对内膜斑块增加的血管扩张反应能力受限。因此，与其他部位相同程度的内膜斑块在内收肌管内的股浅动脉就可产生较严重的狭窄。 * The possible explanations for the discouraging results of infrainguinal endovascular intervention are many. The infrainguinal circulation is characterized by long conduits with a heavy plaque burden, high impedance outflow with low mean flow rates, prolonged fractions of the cardiac cycle with stagnant flow, and a tendency toward exaggerated bending and twisting with skeletal movement. 收肌管是股浅动脉腔内治疗后最易发生治疗失败的部位 植入支架后会立即启动血栓形成及联反应，即血小板聚集、纤维蛋白原激活、纤维素沉积和血栓形成。 * The Incidence of Arterial Stent Fractures with Exclusion of Coronary, Aortic, and Non-arterial Settings J. Rits，Eur J Vasc Endovasc Surg (2008) 36, 339e345 * In 88% of healthy subjects, even muscle activation during maximal plantar flexion leads to occlusion of the popliteal artery due to external compression.9 Biomechanical Incompatibility of Popliteal Stent Placement Knut Kroger， J Endovasc Ther 2004;11:686–694 * * Adjacent angiosomes are interconnected by numerous “choke vessels” that create an integrated compensatory system between different territories the medial calcaneal, medial plantar, and lateral plantar artery angiosomes derived from the posterior tibial artery supplying the entire plantar heel and the medial and lateral plantar surface beyond the toes; the dorsalis pedis angiosome, which extends from the anterior tibial artery, supplying the dorsum of the foot and toes, and also upper anterior perimalleolar vascularization; and the lateral calcaneal arte