대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제82권3호
  • /
  • Pages.541-550
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  • 2021
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  • 1738-2637(pISSN)
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  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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무릎 밑 동맥의 혈관 내 치료의 최신 지견

Current Strategy in Endovascular Management for Below-the-Knee Arterial Lesions

  • 황교수 (건국대학교병원 영상의학과) ;
  • 박상우 (건국대학교병원 영상의학과)
  • Kyosoo Hwang (Department of Radiology, Konkuk University Hospital) ;
  • Sang Woo Park (Department of Radiology, Konkuk University Hospital)
  • 투고 : 2021.03.09
  • 심사 : 2021.05.06
  • 발행 : 2021.05.01
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초록

발을 향해 가는 혈류의 중요한 길목인 무릎 밑 동맥은 다리 혈관 중 가장 가늘며, 협착 등의 병변이 발생하거나 폐쇄가 발생하게 되면 중증하지허혈을 유발할 수 있다. 중증하지허혈이란 말초동맥 질환의 가장 심한 임상 양상 중 하나로서 휴지기 동통, 족부궤양 또는 괴저의 형태로 나타난다. 일반적으로 동맥경화 질환의 진행은 미만성으로 나타나며 대다수의 환자에서 무릎 밑 동맥을 침범한다. 치료의 목표는 동맥혈류 재개통과 사지구제이다. 기술적으로 가능한 경우, 그리고 환자가 걷지 못하는 상태가 아니라면 중증하지허혈이 있는 환자는 혈관의 재개통이 즉시 이루어져야 한다. 따라서 혈관 내 치료는 무릎 밑 동맥을 포함한 모든 환자의 표준 치료가 될 것이며, 혈관재건술을 시행하는 외과의의 임상적 역할은 줄어들 것이다.

The below-the-knee arterial tree is the thinnest of all the leg vessels and is an important path for blood flow to the foot. Hence, lesions including stenosis, especially obstruction, may lead to critical limb ischemia which represents the most severe clinical manifestation of peripheral arterial disease. It is characterized by the presence of ischemic rest pain, ischemic lesions, or gangrene attributable to the objectively proven arterial occlusive disease. Typically, the atherosclerotic disease process involving the below-the-knee arterial tree is diffuse in the majority of patients. The cornerstone of therapy is vascular reconstruction and limb salvage. Revascularization should be attempted whenever technically possible, without delay, in patients presenting critical limb ischemia and when the clinical status is not hopelessly non-ambulatory. Therefore, endovascular treatment can become the gold standard for the full range of patients including below-the-knee, limiting the clinical role of the classically trained surgeons.

키워드

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