重视覆膜支架在外周血管病中的应用

Appreciating the clinical application of covered stent for peripheral vascular diseases

自1991年Parieli率先应用覆膜支架治疗腹主动脉瘤以来,覆膜支架在主动脉病变中得到较广泛的应用,覆膜支架治疗巨大动脉瘤、假性动脉瘤、血管破裂/穿孔、动静脉瘘等病变取得了可喜的结果,在TIPS通道中覆膜支架的1年初次通畅率比裸支架高。目前覆膜支架应用于血管狭窄及闭塞性病变的研究尚少。覆膜支架植入后血管的长期畅通有待进一步观察。对于高度扭曲的血管植入覆膜支架存在困难和挑战。改进支架材料、覆膜结构和推送装置,开发具有自主知识产权的新支架,拓展覆膜支架的新用途,科学合理地应用支架是介入医师面临的重大课题。

Objective Covered stents have been widely utilized in aortic dissections and aortic aneurysms since Parieli treated an abdominal aortic aneurysm with a stent-graft in 1991. Covered stents have also been reported for managing peripheral vascular diseases, including large or wide-neck aneurysm, pseudoaneurysm, vascular rupture/perforation and arteriovenous fistula. Encouraging achievements are also bringing in more than one decade, even in China. For transjugular intrabepatic portosystemic shunt creation, the primary patency rate at 1 year after covered stent grafting is statistically longer than that of bare stent. At present, it is worth studying randomly the covered stent versus bare stent in treating long segmental arterial stenosis and/or occlusion. Furthermore observation should be insisted upon for the long term patency of parent artery after implanting with covered stent. Deploying a covered stent into a tortuous vessel is still a challenge and tough problem. There would still be a long way in China for further development in basic research of improving the substantial property of stent-graft and better design of deploying device. The main target for all interventional radiologists in the foreseen future is how to develop new covered stents with independent knowledge property fight and to expand new horizon for its application. （J Intervent Radiol, 2007, 16： 577- 579）