平肾腹主动脉闭塞的介入治疗:附14例报告

Interventional therapy for juxtarenal aortic occlusion: a report of 14 cases

目的：总结平肾腹主动脉闭塞病变的介入治疗经验。方法：回顾性分析2012年3月—2014年11月收治的14例平肾腹主动脉闭塞患者资料,其中男9例,女5例;年龄42~71岁。临床表现间歇性跛行8例,静息痛5例,足趾坏疽1例（7.2%）;病程1~72个月。所有患者均行多侧孔溶栓导管溶栓后覆膜支架植入治疗。结果：均成功所有患者完成操作。置管溶栓后仅2例肾动脉附近腹主动脉仍可见少量附壁血栓,其余患者腹主动脉内血栓均明显消失。患者均行Kissing技术覆膜支架植入,术后患者下肢缺血症状均明显改善。并发症发生率7.1%,仅1例溶栓后出现后腹膜血肿。随访1~26个月,平均14.8个月,通畅率78.6%。结论：置管溶栓联合覆膜支架置入是一种安全有效的平肾腹主动脉闭塞腔内治疗方法。

Objective： To describe the experience in endovacular treatment of juxtarenal aortic occlusions.Methods： The clinical data of 14 patients with juxtarenal aortic occlusion admitted from March 2012 to November 2014 were retrospectively analyzed. Of the patients, 9 cases were male and 5 cases were female; ages ranged from 42 to 71 years; 8 cases presented with intermittent claudication, 5 cases manifested as rest pain, and one case had toe gangrene, and the course of disease ranged from one month to 72 months. All patients received covered stent implantation after thrombolysis via a multi–side-hole catheter.Results： Interventional procedures were successfully completed in all patients. The thrombi in the abdominal aorta disappeared after catheter-directed thrombolysis in all patients except two cases, in whom little mural thrombi remained. All patients received covered kissing stent placement, after which, their symptoms of limb ischemia were significantly relieved. Follow-up period ranged from one month to 26 months, with average of 14.8 months, and the patency rate was 78.6%.Conclusion： Thrombolytic therapy combined with covered stent placement is a safe and effective endovascular treatment method for juxtarenal aortic occlusion.