锁骨下动脉狭窄和闭塞25例的腔内治疗

Interventional treatment of stenotic or occlusive subclavian artery

目的 回顾性分析介入治疗锁骨下动脉狭窄或闭塞的方法和疗效.方法 2003年10月至2009年9月介入治疗锁骨下动脉病变25例,其中狭窄13例,闭塞12例.单纯行经皮血管球囊成形术（percutaneous transluminal angioplasty,PTA）4例,同时行支架（stenting）植入者20例,植入支架22枚. 结果本组狭窄者技术成功率为100%（13/13）.1例介入治疗失败,闭塞患者技术成功率为91.6%（11/12）.介入治疗后患肢血压明显提高,患/健侧收缩压比由术前（0.60±0.11）mm Hg提高至术后（0.95±0.12）mm Hg,差异有统计学意义（t=10.53,P＜0.01）.临床症状均有不同程度改善,未发生脑卒中和栓塞.25例患者中随访20例,随访时间2～69个月,平均（30±3）个月,2例术后出现再狭窄,再狭窄率为8.3%（2/24）,1例2个月后因脑梗死死亡.1、3年累积通畅率分别为92.5%及81.3%.结论 介入治疗锁骨下动脉病变是一种微创、安全、有效的治疗方法.

Objective To evaluate the methods and efficacy of interventional treatment for subclavian arterial stenosis or occlusion retrospectively. Methods From Oct 2003 to Sop 2009,25 patients with subclavian arterial lesions , including stenosis in 13 cases and occlusion in 12 cases, underwent interventional treatment. Four patients received percutaneous transluminal angioplasty （PTA） alone, and concurrent 22 stents placement were performed in 20 cases. Results The technical success rate in stenotic lesions was 100% and in occluded lesions was 91.6% with a interventional failure in 1 case. Blood pressure increased significantly after interventional treatment. The diseased side/healthy side blood pressure index increased from 0.60 ±0.11 mm Hg preoperatively to （0.95 ±0.12） mm Hg postoperatively（ t = 10.53 ,P 〈0.01 ）. Clinical symptoms improved, and there were no complications with strokes and embolism. 20 cases were followed up for 30 months （ from 2 months to 69 months ）. Restenosis was found in 2 cases and the restenosis rate was 8.3%. The cumulative primary patency rate was 92.5% and 81.3% at 1 and 3 years,respectively. Conclusions Intervention was a less invasive and safe, effective treatment for subclavian arterial lesions.