锁骨下动脉闭塞开通成功率的影响因素分析

Analysis of the factors affecting successful reopening of occluded subclavian artery

目的评价锁骨下动脉闭塞开通成功率的影响因素。方法1998年1月-2007年3月,我科采用腔内支架植入术治疗锁骨下动脉闭塞患者20例。选择顺行入路或双入路,应用超滑导丝开通。结果14例开通成功,6例失败。开通成功患者闭塞段长度和病程平均为3.00 cm和9.83个月,失败患者闭塞段长度和病程平均为2.13 cm和27.6个月。动脉粥样硬化性闭塞开通成功率为80%,大动脉炎性闭塞开通成功率为50%。残端呈"圆头"病变开通成功率为33%,残端呈"尖头"病变成功率为100%,(P<0.05)。顺行入路开通成功率为65%;失败后再行双向开通,成功率为43%。结论病因、病程及残端形态与开通成功率相关性高,病变长度与开通成功率不具明显相关性。顺行开通成功率较高,若开通失败,再行双向开通时成功率明显下降。

Objective To evaluate the factors which might affect the successful reopening of occluded subclavian artery. Methods During the period of Jan. 1998-March 2007, endovascular stent placement was performed in 20 patients with occluded subclavian artery, including 12 males and 8 females, aged 17-74 years （mean 53 years）. The procedures were carried out by using super-slippery guide wire via anterograde or bilateral access. Results Successful reopening of occluded subclavian artery was obtained in 14 cases and the treatment ended in failure in 6 cases. In 14 patients with successful results, the mean length of diseased artery was 3.00 cm and the mean course of disease was 9.83 months, which were 2.13 cm and 27.6 months respectively in 6 cases of failure. The successful reopening rate was 80% in arthrosclerosis cases, while it was 50% in aorto-arteritis ohliterans. The successful reopening rate was 100% in those eases whose occluded artery showing a sharp stump, while the successful reopening rate was 33% in those cases whose occluded artery showing a round stump, with a statistically significant difference between the two （P〈 0.05 ）. The successful rate in cases performed via anterograde access was 65%, and it was only 43% in cases performed via bilateral access. Conclusion The etiology, the duration of disease and the shape of stump bear a close relationship to the successful reopening rate, while no obvious correlation exists between the length of diseased artery and the reopening rate. Higher reopening rate can be achieved when the procedure is performed via anterograde access.