摘要
目的探讨锁骨下动脉病变的临床特点,并分析腔内治疗的效果及安全性。方法回顾性分析2010年10月至2012年12月在复旦大学附属中山医院25例锁骨下动脉病变患者的临床表现、腔内治疗和预后等相关临床资料,分析其临床特点、腔内治疗的疗效和安全性。结果 (1) 25例患者中左侧锁骨下动脉狭窄13例(腔内治疗植入支架13枚),闭塞10例(6例成功植入支架6枚,4例腔内治疗失败),右侧锁骨下动脉闭塞1例(成功植入支架1枚),双侧锁骨下动脉均有病变1例(其左锁骨下动脉闭塞段腔内治疗失败,右锁骨下动脉狭窄成功植入支架1枚)。失败病例均采用传统腋-腋人工血管搭桥手术治疗。(2)锁骨下动脉闭塞的腔内治疗成功率58. 33%(7/12),狭窄的腔内治疗成功率100%(14/14);腔内治疗成功患者患/健侧收缩压差从术前的(30. 67±4. 75) mm Hg降至术后的(12. 93±3. 35) mm Hg(t=15. 26,P <0. 01)。(3)于术后第3、6、12个月及第2、3、4、5年进行随访,行B超或CT血管成像检查,共随访36～60个月。术后第3、6、12个月随访一期通畅率分别为100%、100%和95. 23%;术后第2、3、4、5年的一期通畅率分别为90. 47%、85. 71%、80. 95%和71. 43%。(4)所有患者均未出现术中及术后并发症。结论腔内支架手术具有良好的近期及远期疗效,具有微创、术中术后并发症少、远期通畅率高等优点,已成为锁骨下动脉病变等治疗的首选方法,对于腔内治疗失败的病例,可采取传统手术治疗。
Objective To investigate the clinical features of subclavian artery lesions and analyze the efficacy and safety of endovascular treatment. Methods The related data of clinical manifestations,endovascular treatment and prognosis of 25 patients with subclavian artery disease in Zhongshan Hospital Affiliated to Fudan University from October 2010 to December2012 were retrospectively studied to analyze the clinical characteristics,efficacy and safety of endovascular treatment.Results( 1) In 25 patients,there were 13 cases of left subclavian artery stenosis( 13 stents were implanted by endovascular treatment),10 cases of occlusion( 6 stents were successfully implanted in 6 cases,and 4 cases of endovascular treatment failed),1 case of right subclavian artery occlusion( successful stent implantation),1 case of bilateral subclavian artery lesions( endovascular treatment of left subclavian artery occlusion failed,and right subclavian artery stenosis was successfully implanted with a stent). All failed cases were treated with conventional axillo-axillary bypass graft surgery.( 2) The success rate of endovascular treatment was 58. 33%( 7/12) in subclavian artery occlusion and 100%( 14/14) in subclavian artery stenosis. The systolic blood pressure difference between the affected side and the healthy side decreased from( 30. 67 ± 4. 75) mm Hg before operation to( 12. 93 ± 3. 35) mm Hg after operation( t = 15. 26,P < 0. 01).( 3) The patients were followed up for 36-60 months with B-Ultrasonography or CT angiography( CTA)examinations. The first-phase patency rates were 100%,100% and 95. 23% at postoperative 3-,6-and 12-month,and90. 47%,85. 71%,80. 95% and 71. 43% in postoperative 2-,3-,4-,and 5-year,respectively.( 4) No intraoperative and postoperative complications occurred in all patients. Conclusions Endovascular stent graft surgery has good short-term and long-term curative effects,with the advantages of minimal invasion,less intraoperative and postoperative complications,and high long-term patency rate. It has become the preferred method for the treatment of subclavian artery lesions. If endovascular treatment failed,conventional axillo-axillary bypass graft surgery can be performed.
作者
杨晓虎
林裕辉
徐欣
范隆华
YANG Xiao-hu;LIN Yu-hui;XU Xin;FAN Long-hua(Department of Interventional Radiology,Affiliated Hospital of Nantong University,Nantong,Jiangsu 226001,China)
出处
《中国临床研究》
CAS
2019年第1期57-60,共4页
Chinese Journal of Clinical Research
基金
上海市科学技术发展基金(11ZR1406900)~~
关键词
锁骨下动脉
狭窄
闭塞
腔内治疗
一期通畅率
Subclavian artery
Stenosis
Occlusion
Endovascular treatment
First-phase patency rate
