近肾主髂动脉闭塞病变腔内治疗的疗效评价

Efficacy and safety of endovascular therapy in juxtarenal aortoiliac occlusive diseases

目的探讨近肾主髂动脉闭塞病变(AIOD)患者腔内治疗的安全性及疗效。方法回顾性分析辽宁省人民医院2005年1月至2015年6月17例接受腔内治疗的近肾AIOD患者的临床资料。按Rutherford分级:4级5例,5级9例,6级3例。患者均采用腔内治疗,经股动脉和肱动脉入路,采用球囊扩张、支架植入及保护伞保护内脏动脉,开通病变血管后行球囊扩张和支架植入。结果手术成功率为88.23%。7例患者肾动脉造影后出现狭窄或夹层,其中5例患者植入覆膜支架、1例植入金属裸支架及1例行主髂动脉开窗技术后显影通畅。15例(88.23%)患者临床症状明显改善,术后平均踝肱指数为0.92±0.22,明显高于术前(0.35±0.08),手术前后比较差异有统计学意义(P【0.01)。术后随访5~58个月,平均随访时间(25.6±12.4)个月,术后1年、3年一期通畅率分别为88.2%及82.4%,总体生存率分别为94.1%及82.4%,二期通畅率为100%。2例患者随访期间出现肾动脉再狭窄,经肾动脉球囊扩张后血流通畅。结论对于开放手术高危的近肾AIOD病变患者,腔内治疗不失为一项安全有效的治疗手段,可获得较满意的临床疗效和早中期通畅率。

Objective To evaluate the safety and efficacy of juxtarenal aortoiliac occlusive diseases by endovasular treatment.Methods Data of 17 patients who underwent endovascular treatment from January 2005 to June 2015 in the People's Hospital of Liaoning Province were analyzed retrospectively.According to Rutherford Classification,there were 5 cases of Class IV,9 Class V and 3 Class VI.Through the femoral artery and brachial artery,assisted by filter,angioplasy and stenting to protect visceral arteries,occlusions were treated with percutaneous transluminal angioplasty(PTA) and stenting.Results Techical success rate was 88.23%(15/17).Renal arteries stenosis or dissection occurred in 7 cases.Of them,5underwent covered stent implantation,1 metal bare stent implantation,1 fenestrated technology,and all recovered after treating.Clinical symptoms improved in 15(88.23%) patients.Average value of ankle brachial index(ABI) was improved obviously after operation(0.92 ±0.22 vs 0.35 ±0.08,P <0.01).During the follow-up time of 5~58(mean,25.6±12.4) months,renal artery restenosis occurred in 2 cases and got patent after renal PTA.At 1-,3-year postoperatively,primary patency rate and overall survival rate were88.2% vs 82.4%,94.1% vs 82.4%,respectively.Secondary patency was 100%.Conclusion For patients with high-risk juxtarenal aortoiliac occlusive diseases,endovascular therapy is a safe and effective method,with good clinical outcomes and short and medium term patency.