TASC C型和D型主髂动脉闭塞的腔内治疗及评价

Endovascular treatment for TASC C and D aortofliac occlusive diseases

目的探讨广泛主髂动脉闭塞的腔内治疗方法并评价其疗效。方法32例慢性广泛主髂动脉闭塞患者，男性23例，女性9例，年龄52～81岁，平均69．7岁。其中有明显的静息痛者27例（84．38％），足部局限性坏疽者5例（15．62％）。32例中TASCC型患者13例（40．6％），TASCD型患者19例（59．4％），闭塞段的长度范围为4．5—19．5cm，平均为（14．6±1．2）cm。术前均评估均为高龄、高危病例或不能耐受传统开腹手术的患者。经股动脉或肱动脉人路，针对闭塞血管进行球囊扩张和支架置人或结合股总动脉内膜剥脱等方法进行治疗。结果除3例未能开通外，其余29例均获开通，手术成功率为90．63％，并发症发生率为3，45％。21例患者临床症状中度改善，8例患者临床症状明显改善，术后平均踝肱指数为0．73±0．12，较术前（0．32±0．09）明显升高，差异有统计学意义（P〈0．05）。术后随访4—26个月，平均（13．9±6．2）个月。术后6个月初次通畅率及二次通畅率分别为81．82％、89．09％，术后12个月初次通畅率及二次通畅率分别为63．64％、80．18％。结论对于合并广泛慢性主髂动脉闭塞的高危患者，综合应用多种方法进行腔内治疗是一项安全有效的措施，可获得较满意的临床疗效。

Objective To evaluate the endovascular treatment of diffuse aortoiliac occlusive diseases. Methods Thirty-two patients underwent endovaseular treatment in which rest pain was found in 84. 38% , foot local gangrene in 15.62%. Mean age was 69. 7 years （range, 52 years to 81 years ） and 71.9% was male. Trans Atlantic Inter-Society Consensus C and D disease was respectively in 40. 6% and 59.4% patients. Mean length of vasculopathy was （14. 6 ± 1.2） cm （range, 4. 5 cm to 19.5 cm） All patients had prohibitive risk for open revascularization. With the approach from femoral artery or brachial artery, combined techniques, such as recanalization, balloon dilation, stent placement and concomitant common femoral endarterectomy were used. Results Technical success was achieved in twenty-nine patients（90. 63% ）. The complication rate was 3.45%. Clinical status was markedly improved in eight cases （27.59%） and moderately improved in twenty-one cases（72.41% ）. Mean postoperative ABI was 0.73 ± 0. 12, mean preoperative ABI was 0.32±0.09. Significant differences were seen between postoperative ABI and preoperative ABI （ P 〈 0. 05 ） o Mean time of follow-up was （ 13.9 ± 6. 2） months. At 6 months, primary patency was 81.82% and secondary patency was 89.09%. At 12 months, primary patency was 63.64% and secondary patency was 80. 18%. Conclusion Combined multiple endovascular technique is a safe and effective method in the treatment of poor risk diffuse aortoiliac occlusive diseases.