髂动脉闭塞性病变腔内开通的技术体会和中远期疗效分析

Endovascular treatment for occlusion of iliac artery:analysis of the mid-term to long-term result and review of the technique

目的探讨髂动脉闭塞性病变腔内开通方法和疗效。方法采用超声引导下穿刺、抓捕导丝、预创建抓捕空间等技术经腔内开通后置入血管内支架治疗髂动脉闭塞性病变34例，并回顾分析其髂动脉闭塞患者的技术成功率、并发症发生率及中远期通畅率。结果技术成功率100％，除髂动脉破裂1例（2．94％）外，未发生其他严重并发症。踝肱指数（ABI）由术前的0．40±0．14增至术后7d的0．81±0．13（t=2．67，P=0．02）。随访3～42个月，平均（19．32±2．22）个月；7例发生再狭窄，3例闭塞，经PTA和／或置入内支架解除。患者术后6个月，1，2，3年一期通畅率和辅助一期通畅率按随访顺序依次为86．27％，74．40％，61．81％，52．98％和96．43％，92．57％，85．96％，85．96％。二期通畅率4个随访期均为100％。术后6个月，1，2，3年的肢体一期通畅率及辅助一期通畅率依次为88．41％，77．53％，65．79％，57．56％和96．97％，93．51％，87．27％和87．27％。二期通畅率均为100％。结论超声引导下穿刺、抓捕导丝、预创建抓捕空间等技术的综合运用可提高髂动脉闭塞段开通的成功率；腔内治疗中远期通畅性的维持需要严密随访和对再狭窄、闭塞的及时处理。

Objective To study the therapy effect and review of the technique of endovascular treatment for iliac artery occlusion. Methods Thirty-four patients with occlusion of iliac artery were treated with endovascular therapy. The technical success rate, complication rate, the mid-term to long-term results were analyzed. Results The technical success rate was 100%. Iliac artery rupture in one case（2.94% ） and no other major intraoperative complication occurred. Ankle-brachial index increased from （0.40 ± 0.14 ） to （ 0.81 ± 0.13 ） （ t = 2.67, P = 0.02 ）. All patients were followed up with mean time （ 19.32 ± 2.22 ） months（ range from 3 to 42 months）. Iliac artery re-stenosis occurred in seven cases and re-occlusion in 3 cases. The primary, primary-assisted and secondary patency rate was 86. 27% , 74.40% , 61. 81% , 52.98% ; 96.43% , 92.57% , 85.96% , 85.96% and 100% , 100% , 100% , 100% at 6m, 1 , 2, 3 years after treatment, respectively. Conclusious Comprehensive application of ＂ capturing guide wire＂ and other endovascular techniques can improve the success rate of recanalization of iliac artery occlusion.Maintenance of mid-term and long-term patency of endovascular treatment requires careful follow-up and prompt treatment of restenosis and reocclusion.