髂动脉支架联合股动脉内膜剥脱术治疗多节段髂股动脉闭塞症

Combined iliac artery stenting and open femoral endarterectomy in the treatment of multi-level iliac and common femoral occlusive disease

目的探讨多节段髂股动脉闭塞症的治疗手段及临床疗效。方法选择2008年1月2011年6月间采用髂动脉支架植入联合股动脉内膜剥脱＋补片成形术治疗的多节段髂股动脉硬化闭塞症36例患者，其中男性26例，女性10例；年龄49～87岁，平均65岁。对患者的随访结果进行回顾性分析，评价术前、后患者临床症状改善情况，采用Kaplan—Meier生存分析比较不同Fontaine分级患者间一期通畅率的差异，采用Cox回归分析筛选影响一期通畅率的独立因素等。结果本组患者手术均获成功，术后34例（94．4％）临床症状得到明显改善。平均随访24．2个月，一期通畅率为72．2％，辅助一期通畅率为83．3％，二期通畅率为94．4％。生存分析显示Fontaine11级患者一期通畅率明显高于Ⅲ、Ⅳ级患者（P=0．041、0．012）。Cox回归分析未发现影响术后一期通畅率的独立因素。结论髂动脉支架植入联合股动脉内膜剥脱＋补片成形术是治疗多节段髂股动脉闭塞症的有效方法，随访结果良好。

Objective To evaluate the feasibility and efficacy of hybrid procedure for the treatment of multi-level iliac and common femoral occlusive disease. Methods From January 2008 to June 2011, 36 lower limbs with sever iliac and common femoral occlusive diseases were treated by iliac artery stenting combined with open femoral endarterectomy. The mean age of the whole study population was 65 years （ range 49 to 87 years） with a male predominance （26 males, 72. 2% ）. The early clinical results were determined by ankle brachial index and intermittent claudication distance. Patency analyses were performed using Kaplan-Meier life tables. Univariate and multivariate analysis were used to assess the influence of various risk factors on primary patency. Results All lower limbs underwent successful hybrid surgical and endovascular therapy. Clinical improvement was seen in 94. 4% of patients. The mean duration of follow-up was 24. 2 months, overall, the primary patency rates, primary assisted patency rates and second patency rates were 72. 2%, 83.3% and 94. 4% respectively. The primary patency rate for intermittent claudication was significantly higher than that for critical limb isehemia （P = 0. 041,0. 012 ）. Cox regression analysis did not reveal any independent predictor of primary patency. Conclusion Hybrid procedures provided an effective treatment management of multilevel iliac-femoral arterial occlusive disease.