经皮穿刺锁骨下动脉腔内成形术

Percutaneous transluminal angioplasty of the subclavian artery

目的 评价经皮穿刺锁骨下动脉腔内成形术的效果及安全性。方法 对 76例锁骨下动脉严重狭窄或完全闭塞的患者行经皮经腔血管成形术 (PTA)。所有患者均有椎基底动脉和 (或 )上肢动脉供血不足症状。术前DSA证实锁骨下动脉狭窄 6 9例 ,完全闭塞 7例。行单纯球囊扩张术6 8例 ,置入支架 8例。结果 PTA术后所有患者症状均消失或明显减轻。DSA、经颅多普勒超声(TCD)显示 45例患者锁骨下动脉窃血被纠正 ,有 3例出现并发症 (2例穿刺部位假性动脉瘤形成 ,1例术中一过性眩晕瞬间恢复 )。经 4～ 35个月的随访 (平均 2 9个月 ) ,发生再狭窄 3例。结论 PTA治疗锁骨下动脉严重狭窄或完全闭塞是有效和安全的 ,并发症低于手术治疗。

Objective To evaluate the effect and safety of percutaneous transluminal angioplasty (PTA) of subclavian artery. Methods 76 patients with severe stenosis or total occlusion of subclavian artery were treated with PTA . Symptoms of vertebrobasilar and (or) upper extremity arterial insufficiency were present in all patients. Digital subtraction angiography (DSA) showed that 69 had severe stenosis and 7 had total occlusion of the subclavian artery before PTA. 68 lesions were successfully dilated and stents were implanted in other 8 lesions. Results The symptoms disappeared or alleviated obviously in all patients after PTA. DSA and transcranial Doppler ultrasonography (TCD) confirmed that subclavian steal was corrected in 45 patients.There were only 3 minor complications (2 pseudoaneurysms at puncture site, 1 transient dizziness during PTA). During the follow up of 4 to 35 months (average 29 months), there were only three re stenosis. Conclusion PTA is an effective and safe method to treat severe stenosis or total occlusion of subclavian artery. The rate of complications was lower than that of operative treatment.