腔内血管成形术治疗髂动脉长段慢性完全闭塞性病变

Endovascular angioplasty for the treatment of long iliac artery chronic total occlusions

目的评价腔内血管成形术治疗髂动脉长段慢性完全闭塞性病变（CTO）的可行性、有效性及安全性。方法回顾性分析2006年1月至2010年12月经腔内血管成形术治疗的病变长度〉5cm的髂动脉CTO患者139例（157条患肢）的临床资料。其中男性93例（105条患肢），女性46例（52条患肢）；年龄50～96岁，平均年龄（77±10）岁。TASC11分型：B型18例，C型89例，D型32例。采用左肱动脉和（或）股动脉穿刺经内膜下或血管内行髂动脉闭塞的球囊血管成形联合支架植入术治疗。结果技术成功率96．2％（151／157）。踝肱指数由术前的0．42±0．19上升到术后的0．81±0．26。随访6～53个月，平均随访（30±7）个月，髂动脉支架畅通率94．1％（111／118），7例发生支架内再狭窄或闭塞，无髂动脉破裂、支架移位、穿刺动脉假性动脉瘤及动静脉瘘的发生。结论腔内血管成形术治疗髂动脉长段CTO安全、有效，术后支架通畅率高，联合肱动脉和股动脉双向穿刺技术能够显著提高技术成功率。

Objective To evaluate the effectiveness, safety and feasibility of endovascular angioplasty in treating long iliae artery chronic total occlusions （CTO）. Methods The clinical data from a consecutive series of patients with long （ 〉5 cm） iliac artery CTO who treated by endovascular angioplasty from January 2006 to December 2010 was retrospectively analyzed. There were 139 patients （157 limbs） with long iliac artery CTO treated by endovascular angioplasty in this study [ male 93 and female 46, mean age （77 ± 10） years]. According to TASC II classification, there were 18 patients in type B, 89 patients in type C and 32 patients in type D. Recanalization of the occluded lesions was attempted with the left brachial and/or femoral access. Results The ankle braehial index increased from 0. 42 ± 0. 19 before treatment to 0. 81 ± 0. 26 after treatment. The rate of technical success was 96. 2% （151/157） and the patency rate of iliac artery was 94. 1% （111/118） during the follow-up. Significant restenosis or reocclusion was found in 7 iliac lesions and there were no major interventional complications, such as iliae artery rupture, stent displacement, pseudoaneurysms, and arteriovenous fistula. Conclusions Endovascular angiopiasty is an effective, safe and feasible method in treating long iliae CTO with high pateney rate. Combined left brachial and femoral access can increase the technical success rate significantly.