左锁骨下动脉急性闭塞与动脉夹层

Acute occlusion of left subclavian artery with artery dissection

目的通过对46例左锁骨下动脉急性闭塞患者的造影诊断和经皮腔内血管成形术治疗,探讨动脉夹层与左锁骨下动脉急性闭塞的关系、病理特点及经股动脉-肱动脉逆行双路径腔内血管支架植入术的治疗方法、疗效、适应证及并发症。方法对46例锁骨下动脉急性闭塞的患者采用经股动脉-肱动脉双路径诊断动脉夹层,采用经股动脉-肱动脉双路径腔内血管支架植入技术治疗左锁骨下动脉急性闭塞患者46例。结果造影证实左锁骨下动脉近端动脉夹层并左锁骨下动脉急性闭塞38例,降主动脉内膜下出血(DebackeyⅢ)不典型型并发左锁骨下动脉急性闭塞8例,植入支架46枚,全部成功,仅4例发生短暂左上肢缺血;支架植入后,造影证实左锁骨下动脉血流方向恢复正常、左椎动脉血流方向恢复正常;术后采用彩色多普勒超声、经颅多普勒超声(TCD)和(或)数字减影血管造影(DSA)复查随访2周至12个月,证实支架位置恒定、血流方向正常、无再狭窄。结论左锁骨下动脉近端动脉夹层、主动脉内膜下出血可引起左锁骨下动脉急性闭塞,而导致锁骨下动脉窃血综合征,经股动脉-肱动脉双路径腔内支架植入术治疗效果可靠、操作方法简单安全。

Objective To study the relationship between the artery dissection and the acute occlusion of left subclavian artery; to explore the effect,the indications and the complications of the technique of stent placement from the femoral artery and the brachial artery, basing on 46 cases who suffered from the acute occlusion of the left subclavian artery. Methods Forty-six patients with acute occlusion of left subclavian artery were confirmed having artery dissection by angiography from femoral artery and brachial artery. Using the technique of stent placement from the femoral artery and the brachial artery,clinical cure was achieved in all the patients. Temporary ischemic symptom in left upper limbs occurred only four patients. Results Thirty-eight patients were confirmed having the acute occlusion of left subclavian artery and the artery dissection by angiography, 8 patients had the acute occlusion of left subclavian artery and Debackey Ill. Clinical cure was achieved in all the patients. The left subclavian artery and the left vertebral artery had a well blood stream in angiography after stent placement. With 2 to 12 months follow-up,the stent had a stable position and no restenosis in all the cases. Conclusion Both the left subclavian artery dissection and the hemorrhage in the below membrane of the aorta can cause the acute occlusion of the left subclavian artery and the subclavian artery steal flow syndrome. The technique of stent placement in subclavian artery from the femoral artery and the brachial artery is one of safe and effective means for the treatment of the acute occlusion of the left subclavian artery and the subclavian artery steal flow syndrome.