镍钛合金支架治疗股浅动脉粥样硬化闭塞症的疗效分析

Implantation of nitinol stent for the treatment of superficial femoral atherosclerosis obliterans

目的 探讨镍钛合金支架治疗股浅动脉粥样硬化闭塞症（ASO）的疗效.方法 回顾性分析自2009年1月至2013年2月采用动脉支架植入治疗的132例（139条肢体）股浅动脉ASO的临床病例.股浅动脉病变的长度2.4～25.9（12.6±8.8）cm.Fontaine分级：Ⅱa 26条,Ⅱb 52条,Ⅲ43条,Ⅳ18条.TASC-Ⅱ（泛大西洋介入学会联盟）分型：A型33条,B型51条,C型40条,D型15条.术后第6、12、24、36个月进行门诊随访患者临床症状、踝肱指数（ABI）、彩色多普勒超声检查（CDU）,动脉CT血管显像（CTA）和（或）动脉造影评估支架的通畅情况,利用生存分析统计支架的通畅率和保肢率,观察临床症状的改善情况.结果 ABI由术前0.31±0.22增至术后0.80±0.28;流出道通畅的3支有41条、2支有55条、1支有43条.随访时间14～36个月,术后6、12、24、36个月的一期通畅率分别为97.0％、81.1％、75.3％、65.1％,二期通畅率分别为98.6％、88.6％、77.8％、73.7％.闭塞长度≥15 cm和＜15 cm的3年通畅率分别为50.8％、73.1％;1支流出道和流出道≥2的3年通畅率分别为59.2％、71.4％;TASC-ⅡA、B和C、D型的3年通畅率分别为75.6％、57.1％;Fontaine分级Ⅱ和Ⅲ、Ⅳ3年通畅率分别为76.8％、50.3％.3年保肢率为93.5％.结论 镍钛合金支架治疗股浅动脉ASO安全、有效.病变长度越短,Fontaine分级越早,流出道越多,越有利于保持较高通畅率.

Objective To explore the efficacy the implantation of nitinol stent for the treatment of superfi- cial femoral atherosclerosis obliterans. Methods 139 limbs in 132 patients with superficial femoral ASO [mean length （12.6＋8.8）cm, range 2.4-25.9 cm] were selected for percutaneous treatment with the nitinol stent from January 2009 to February 2013, and the patients were retrospectively analyzed. On the basis of Fontaine grade, they were classified as Ⅱ a（ n=26 ）, Ⅱ b （n=52 ）,Ⅲ （n=43）, Ⅳ （n= 18 ）. According to TASC- Ⅱ , the lesions were classified as type A in 33 limbs, type B in 51 limbs, type C in 40 limbs, and D in 15 limbs. The treated superfi- cial femoral artery was assessed for patency and degree of stenosis by CDU, CTA and angiography at 6, 12, 24 and 36 months after the stent implantation. The survival analysis was used to derive primary and secondary patcncy rates, limb salvage rate, compare to the patency rate for each group, and observe the improvement of clinical symptoms. Results ABI from preoperative 0.31±0.22 rose to postoperative 0.80±0.28. Distal runoff： three of the 41 cases, two of the 55 cases, one of 43 cases. At 6, 12, 24 and 36 months, the primary patency rates were 97.0%, 81.1%, 75.3%, 65.1%, the secondary patency rates were 98.6%, 88.6%, 77.8%, 73.7%, respectively. At 3-year, patency rates were 50.8%, 73.1% for occlusion length≥ 15 cm and 15 cm respectively, a tributary of the debut, 59.2%, 71.4% for distal runoff=1 and ≥2 respectively, 75.6%, 57.1% for TASC- Ⅱ A and B VS C and D respectively, 76.8%, 50.3% for Fontaine stage Ⅱ VS Ⅲ and Ⅳ 3 respectively. At 3-year the limb salvage rate was 93.5%. Conclusion Implantation of the nitinol stent for the treatment of superficial femoral artery ASO is safe and effective, can be used as the preferred clinical treatment. The shorter the length of lesion, the lower of Fontaine grade, the more of the outflow are conducive to maintaining the higher patency rate.