血管内支架在放疗后动脉损伤中的应用

Endovascular stents in arterial injury after radiotheapy

目的：用于评价内支架放置术在放疗后所致动脉疾病的治疗，及靶血管内内支架的长期支撑开放作用。方法：１３个内支架放置于８个放疗后动脉性疾病的患者，其分别治疗血管闭塞３例，动脉瘤１例，残存狭窄２例，多发狭窄１例，球囊成形术后再发狭窄１例。所有病例均用ＣＴ扫描和／或多普勒超声检查，观察内支架及其靶血管内和内支架内的血流情况。结果：介入方法成功治疗８例放疗后所致动脉疾病的患者。５例动脉病变基本消失，追踪２年（８月～５年），临床症状完全解除，３例临床症状改善。５例患者接受了１或２次介入治疗。１例患者重复承受了４次血管成形术，并放置了３个内支架，２个内支架放在两髂总动脉和腹主动脉，１个内支架放在腹腔动脉。另１例重复４次血管成形术的患者，在肠系膜上动脉放置了２个内支架。最后１例，因为血管成形术后内膜撕裂和血管闭塞，而放置了１个内支架，经５年随访，其动脉病变为临床治愈。结论：我们结果提示；单一的内支架放置或者多技术综合运用，可有效治疗放疗所致的动脉性病变，应考虑其为动脉损伤性病变的首选治疗。

Purpose: To assess the primary success and patency of stenting for the treatment of radiation induced arterialdisease. Methods: Thrteen stems were placed in 8 patients to treat occlusion (n= 3), aneUrysm (n=1), residual stenosis (n=2), multiple stenoses (n=1), and delayed restenosis after previous balloon angioplasty (n=1). The prostheses were readilyvisualized and the patency within the stent and the target arteries s were determined with Doppler US and/or CT scanner in all patients. Results: Five of these patients demonstrated primary patency with relief of clinical symptoms with a mean follow-up of 2years (range, 8 months-60 months). Clinical improvement was noted for the other patients. One patient has undergone PTAfour times and three stems were installed, two of which were in the area of the aortic bifurcation, and one in the celiac trunk.Another patient has also undergone PTA four times and two stems were placed in the superior mesenteric artery. A stent was implanted in one patient because of PTA-induced dissection and occlusion and his arterial lesion was considered to be cured clini cally after a follow-up of 5 years. Conclusion: Our results suggest that stent placement with single or multiple techniques may beeffective immediately in arterial lesions caused by radiation and can be considered as the first therapeutic option in these cases.