内膜下血管成形术治疗外周动脉闭塞性疾病13例

Subintimal angioplasty in the treatment of peripheral artery occlusive disease

目的评价内膜下血管成形术在治疗外周动脉闭塞性疾病中的应用价值。方法总结2004年5月至2006年5月北京协和医院血管外科对13例髂动脉和锁骨下动脉完全闭塞患者行内膜下介入治疗,同时行球囊扩张和支架植入术的临床资料。结果13例患者中,闭塞段动脉介入治疗均获得成功,闭塞动脉平均长度4．9 cm（2-8 cm）,主要症状均得到改善,无并发症。髂动脉闭塞的术前、术后平均踝-肱比（ABI）,分别为：0．39（0-0．83）,0．94（0．73～1．3）,P=0．004,差异有统计学意义。锁骨下动脉闭塞的病例术后双上肢血压均恢复一致,平均随访时间11个月（3～18个月）,随访率76．9％,支架1年通畅率100％（12／12枚）。结论内膜下血管成形术在外周动脉闭塞性疾病中有很好的应用价值,方法可靠,安全,近期通畅率较好,远期通畅率尚需要进一步随访。

Objective To evaluate subintimal angioplasty in patients with peripheral artery occlusive disease. Methods From May 2004 to May 2006, 13 patients with iliac artery or subclavian artery occlusion underwent subintimal angioplasty, i.e. percutaneous transluminal angioplasty and stent placement. Results Initial success was achieved in all the 13 patients with an improvement in both the symptoms and the mean increase of ankle-brachial index of 0. 55（range, 0. 39 -0. 94, P =0. 004） without any complication. The mean length of the stent was 4. 9 cm（ range, 2 -8 cm）. Blood pressure in the diseased upper extremities reached the level of contralateral extremities in patients with subclavian artery occlusion. Mean follow-up period was 11 months （range, 3 - 18 months）. During follow-up all stents are patent and patients are symptoms free. Conclusion Subintimal angioplasty is technically feasible in most patients, there are few complications and short-term patency rate is satisfactory.