复杂锁骨下动脉闭塞性病变的腔内治疗

Endovascular therapy for complex subclavian artery occlusive diseases

目的探讨复杂锁骨下动脉闭塞性病变腔内治疗的特点。方法回顾首都医科大学宣武医院血管外科2012年1月至2013年12月期间治疗的92例复杂锁骨下动脉闭塞性病变患者临床资料,分析患者的病变特点、腔内手术治疗成功率、联合入路应用、术后症状改善等。结果将复杂锁骨下动脉闭塞性病变分为3型:Ⅰ型为左侧锁骨下动脉长段闭塞,Ⅱ型为右侧锁骨下动脉开口处狭窄或闭塞,Ⅲ型为伴有椎动脉开口病变或影响椎动脉开口的锁骨下动脉狭窄或闭塞。本组患者手术成功率为82.6%。27.2%患者选用股动脉和肱动脉联合入路,提高了手术成功率。术后患者症状改善率为81.6%。结论上肢动脉入路能够提高左侧锁骨下动脉长段闭塞的开通率,保证右锁骨下动脉开口处支架的准确定位。锁骨下动脉闭塞性病变腔内手术治疗过程中要注意保护椎动脉。

Objective To discuss the key points of endovascular therapy for complex subclavian artery occlusive diseases.Methods During the period from January 2012 to December 2013,a total of 92 patients with complex subclavian artery occlusive disease were admitted to Xuanwu Hospital of Capital Medical University,Beijing,China.The clinical data were retrospectively analyzed.The features of the lesions,the success rate of endovascular therapy,the use of combined approaches,the relief of symptoms after treatment,etc.were evaluated.Results The complex subclavian artery occlusive diseases could be divided into three types.Type Ⅰ：long segment of the left subclavian artery was occluded; type Ⅱ：ostial stenosis or occlusion of the right subclavian artery; and type Ⅲ：subclavian artery stenosis or occlusion was associated with the ostial disorder of the vertebral artery,or the opening of vertebral artery was affected by the subclavian artery stenosis or occlusion.The technical success rate was 82.6%.Combination use of femoral artery and brachial artery approach was employed in 27.2% of patients,which had improved the technical success rate.After the treatment the symptom improvement rate was 81.6%.Conclusion Upper limb artery approach can improve the re-canalization rate of left subclavian artery with long segment occlusion,and can ensure the accurate positioning of stent at the site of right subclavian artery opening.During the procedure of endovascular intervention for subclavian artery occlusion disease,attention should be paid to the protection of the vertebral artery.