血管腔内支架治疗动脉狭窄性病变的临床分析

Endovascular treatment for peripheral arterial stenosis with endoluminal stent

目的 初步评价金属内支架治疗动脉狭窄性病变的疗效及安全性。 方法 利用血管腔内支架置入共治疗 34例动脉狭窄性病变 ,其中降主动脉 1例 ,髂动脉 2 7例 ,股动脉 2例 ,颈动脉 1例 ,锁骨下动脉 2例 ,肾动脉 1例。动脉硬化性病变 33例 ,多发性大动脉炎 1例。动脉经皮穿刺 2 6例 ,动脉直视下穿刺 8例。 结果 34例血管腔内支架均置放成功 ,1例降主动脉段病例于术后当日死亡 ,系降主动脉破裂。球囊扩张后动脉形成夹层分离有 13例 ,穿刺点血肿形成 11例。颈动脉段 1例术中及术后未发生TIA及脑梗塞。下肢动脉各段术中及术后未发生远端肢体动脉急性栓塞。踝肱指数从术前平均 0 4 5升至 0 72。 2例锁骨下动脉病变患者术后患肢血压恢复正常。 1例肾动脉狭窄患者血压从术前 180 / 12 0mmHg下降至 140 / 90mmHg。所有存活病例均得到随访 ,随访 1～ 2 6个月 ,2例髂动脉病变分别于术后 4个月及 6个月血栓形成 ,余扩张段动脉均通畅。 结论 血管腔内支架对动脉狭窄性病变疗效满意 ,尤其适用于髂动脉、锁骨下动脉短段狭窄的患者。对颈动脉狭窄性病变使用需慎重。

Objective To initially evaluate the effect and security of endovascular treatment for arterial stenosis with endoluminal stent. Methods Thirty-four cases of arterial stenosis were treated with endoluminal stent from March 1999 to May 2001. The stenosis involved descending aorta (1 case), iliac artery (2), femoral artery (2), carotid artery (1), subclavian artery (2) and renal artery (1). Thiry-three cases had arteriosclerosis and one Takayasu′s arteritis. Twenty-six cases were percutaneously punctured and eight cases were punctured directly. Results All the 34 cases had the stents successfully implanted. However, one case of descending aorta stenosis died on the operation day due to rupture of the descending aorta. Dissection was performed in thirteen cases after balloon dilation and hematoma was seen at the pucturing point in eleven cases. TIA (transient ischemia attack) and cerebral infarction did not occur in the case of carotid arterial stenosis. For those with stenosis in lower extremities, ABI (ankle-brachial index) increased from 0.45 to 0.72 postoperatively. The brachial pressure of two cases of subclavian arterial stenosis returned to normal postoperatively. The blood pressure of case of renal arterial stenosis reduced from 180/120 mm?Hg to 140/90 mm?Hg. All the cases were followed up for one month to 26 months. Thrombosis of the arteries treated occarred in two cases of iliac arterial stenosis four and six months postoperatively. Conclusions The effect of endovascular treatment for arterial stenosis with endoluminal stent is satisfactory. Endovascular therapy is especially suitable for iliac arterial and limited stenosis of the subclavian artery. However, it should be cautiously used in the stenosis of the carotid artery.