“一站式”腔内治疗冠心病合并主动脉粥样硬化性疾病的探讨

"One-stop" endovascular treatment for concomitant coronary heart disease and aortic atherosclerotic disease

目的：探讨冠状动脉介入治疗（PCI）联合主动脉腔内修复术（EVAR）“一站式”治疗冠心病和主动脉粥样硬化性疾病的临床策略及其安全性。 方法：回顾性分析2016年1月—2016年6月中国医学科学院阜外医院行腔内治疗的7例合并冠心病的主动脉粥样硬化性疾病患者资料，其中男6例，女1例，平均年龄76.2（64-86）岁，术前主动脉CT和冠脉CT确诊主动脉病变和冠脉病变并存，术中造影确认主动脉和冠脉病变均符合介入治疗指征后，实施“一站式”手术治疗。 结果：手术成功率100%，无围术期死亡。术后并发症包括切口附近皮下瘀斑2例，其中合并血肿1例，后者因血色素下降予以输注浓缩红细胞2U治疗。1例主动脉弓降部溃疡患者以烟囱技术重建左锁骨下动脉，其左侧肱动脉穿刺点出现假性动脉瘤，予以外科修复。所有患者均获得门诊或电话随访，随访时间7（6-10）个月，所有患者临床症状消失或明显减轻，生活质量改善，无再次手术或死亡。 结论：PCI联合EVAR“一站式”治疗冠心病和主动脉粥样硬化性疾病早中期疗效满意，切口或穿刺部位出血性并发症应予警惕。术后药物治疗方案严格按照冠心病的治疗原则进行。

Objective：To investigate the clinical strategies and safety of“one-stop＆quot;solution by combination of percutaneous coronary intervention （PCI） endovascular aortic repair （EVAR） for concomitant coronary heart disease and aortic atherosclerotic disease. Methods：The clinical data of 7 patients with aortic atherosclerotic disease and concomitant coronary heart disease undergoing endovascular treatment in Fuwai Hospital from January 2016 to June 2016 were retrospectively analyzed. Of the patients, 6 cases were male and 1 case was female, with an average of 76.2 （64–86） years of age;the co-existence of aortic atherosclerotic disease and coronary heart disease was conifrmed by preoperative aortic and coronary CT imaging, and all underwent“one-stop”operation atfer veriifcation of indications for interventional therapy in both aortic and coronary artery lesions by intraoperative angiography. Results：hTe operative success rate was 100%and no perioperative death occurred. Postoperative complications included subcutaneous ecchymosis near the incision site in 2 cases, of whom, 1 case complicated with hematoma and given transfusion received 2 U packed red blood cells due to hemoglobin decline. One case with descending aortic arch ulcer undergoing reconstruction of the left subclavian artery by chimney technique, developed pseudoaneurysm at the puncture site of the letf brachial artery, and then underwent surgical repair. All patients were followed up by outpatient visit or telephone contact, and during the follow-up period of 7 （6–10） months, their symptoms had disappeared or were signiifcantly alleviated, with improved quality of life;no repeat operation was required and no death occurred. Conclusion：“One-stop”treatment by PCI and EVAR for concomitant coronary heart disease and aortic atherosclerotic disease has satisfactory short-and mid-term efficacy, and precaution should be taken for the hemorrhagic complications in the incision and puncture site. Postoperative medications should be strictly given according to the principle for coronary heart disease treatment.