锁骨下动脉完全性闭塞的血管内治疗

Interventional therapy for complete occlusion of subclavian artery

目的讨论锁骨下动脉完全性闭塞介入治疗方法的可行性、安全性和有效性。方法对28例锁骨下动脉(28支)近端完全闭塞合并有椎-基底动脉供血不足和(或)上肢缺血症状患者进行回顾性分析。其中男20例,女8例;年龄为42～76岁,平均为56岁。根据DSA显示闭塞段形态,应用导丝开通、球囊扩张及支架置入的方法进行治疗。经股动脉穿刺为顺行方式,经病变的股动脉和桡动脉穿刺为逆行方式。结果通过顺行方式开通19例,逆行开通9例。25例开通成功并置入自膨式支架,失败3例,成功率为89%(25/28);25例患者置入支架后,症状、体征明显改善。患者双上肢收缩压差由术前>20mm Hg,恢复至术后<10 mm Hg;术后TCD显示,椎动脉血流均由逆向转为正向。25例成功置入支架患者中,术后随访23例,失访2例,随访时间为2～48个月,平均24个月。有2例分别于术后12个月和15个月时出现支架内再狭窄,再次予以球囊扩张术和支架置入术,取得满意疗效。结论掌握好适应证,血管内机械性再通及支架置入术治疗锁骨下动脉闭塞是一种安全、可行、有效的方法 。

Objective To discuss the method, feasibility, safety and efficacy of interventional therapy for complete occlusion of subclavian artery. Methods A complete of 28 patients with complete occlusion of unilateral proximal subclavian artery and complicated with vertebrobasilar artery insufficiency and/or upper limb ischemia were analyzed retrospectively. They were treated by using guide wire for balloon dilatation of the arteries and stent implantation according to the vascular morphology showed on the digital subtraction arteriography （DAS）. Results The arteries of 25 patients were successfully recanalized and stents were implanted, and 3 patients were failed. The symptoms and signs of the 25 patients were improved significantly after stenting. Twenty-three patients were followed-up, and 2 were lost to follow up. The follow-up period was 2 to 48 months （mean, 24 months）. Two patients developed restenosis 12 and 15 months after stenting, they were treated again with percutaneous angioplasty and stenting, and satisfactory results were achieved. Conclusion Endovascular mechanical recanalization and stenting in the treatment of subclavian artery occlusion is a safe, feasible and effective method.