摘要
目的评估经皮血管成形术治疗锁骨下动脉狭窄的安全性及近-中期疗效。方法连续152例住院患者,男88例,女64例,年龄17~82(58±16)岁,共179条(单侧125例,双侧27例)锁骨下动脉严重狭窄(直径狭窄70%~100%),病因分别为动脉粥样硬化114例(75%)和大动脉炎38例(25%),因患侧上肢间歇性运动无力130例(85.5%),锁骨下动脉窃血138例(90.8%),冠状动脉窃血综合征2例(1.8%),蓝指综合征2例(1.8%),或准备用患侧乳内动脉旁路移植的无症状患者10例(6.6%),经股动脉(n=96)、肱动脉(n=25)或桡动脉(n=3)和联合(n=28)路径行经皮血管成形术,并随诊9个月观察手术的疗效。结果 133处狭窄性病变(直径狭窄70%~99%)经皮血管成形术均获成功(100%),46处完全闭塞性病变中36处经皮血管成形术成功(78.2%)。其中145处病变因单纯球囊成形结果不够满意而置人支架。经皮血管成形术成功后病变狭窄程度从术前的(90±8)%降至(5±8)%,病变动脉直径从术前的(1.0±0.9)mm 升至(7.0±0.5)mm(P 值均<0.0001)。未发生严重的并发症。经皮血管成形术成功的142例患者术后随访9个月,其中135例患者血管通畅,疗效稳定,另有7例发生再狭窄,其中4例为大动脉炎患者,3例为动脉粥样硬化患者。结论经皮血管成形术治疗锁骨下动脉狭窄安全,近-中期疗效好,远期疗效有待进一步调查。
Objective To evaluate the safety and efficacy of percutaneous transluminal angioplasty (PTA, with or without stents) for the treatment of patients with subclavian artery stenosis. Methods Using the brachial ( n = 25 ) , radial ( n = 3 ) , femoral ( n = 96 ) , or combined ( n = 28 ) approach, PTA was performed in consecutive 152 [ bilateral n=27, unilateral n = 125, 88 male, aged 17~82 (58 ± 16 )years old] subclavian artery stenosis patients with 179 lesions. Stenosis was caused by atheroma in 114 of 152 patients (75%) and by aortoarteritis in the other patients (25%). The indications for intervention were arm claudication in 130 of 152 patients ( 85.5% ), subclavian steal in 138 of 152 patients ( 90. 8% ), blue finger syndrome in 2 of 152 patients( 1.3% ), coronary steal syndrome in 2 of 162 patients( 1.3% ), or anticipated coronary artery bypass grafting using the internal mammary artery in 10 asymptomatic patients (6. 6% ). All patients were followed up for at least 9 months after procedure. Results PTA was succeeded in 142 of 152 patients (93.4%)and procedural success rate was 100% in 133 stenotic lesions (diameter reduction 70% ~99% ) and 78. 2% in total occlusive lesions (36/46). Stents were deployed in 145 of 169 lesions. In the 142 patients successfully treated with PTA, the percent diameter stenosis was reduced from (90 ± 8) % to (6 ± 8 ) % , and lesions diameter improved from ( 1.0 ± 0. 9) mm to (7.0 ± 0. 5 ) mm ( all P values 〈 0. 001). No severe procedure related complications were observed. During 9 months follow-up in these 142 patients with successful PTA, sustained clinical improvement was seen in 135 patients and restenosis occurred in 7 patients with aortoarteritis ( n = 4 ) and atheroma ( n = 3 ) . Conclusions Percutaneous transluminal angioplasty is effective and safe for the treatment of subclavian artery stenosis.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2007年第4期316-319,共4页
Chinese Journal of Cardiology