锁骨下动脉狭窄和闭塞病变的腔内治疗

Intracavitary therapy for subclavian artery stenosis and occlusion lesions

目的探讨锁骨下动脉狭窄和闭塞病变腔内治疗的可行性和安全性。方法回顾性分析20例锁骨下动脉狭窄和闭塞病变腔内治疗患者的资料,患者术前行颈部血管超声、头颈部CT血管造影术(CTA)及经颅多普勒(TCD)等检查,行数字减影血管造影(DSA)下造影并行腔内治疗,术后随访1~26个月,观察临床疗效。结果 19例患者手术获得成功,行锁骨下动脉支架成形术,其中股动脉入路18例,股动脉联合肱动脉入路1例,术后锁骨下狭窄或闭塞病变解除,血流通畅,椎动脉恢复为正向血流,技术成功率95%(19/20),患者临床症状明显改善,术后双上肢收缩压压力差为6~12 mm Hg(1 mm Hg=0.133 k Pa),平均为(7.9±1.6)mm Hg,与术前比较差异有统计学意义(t=17.68,P<0.01)。围手术期未出现异位栓塞及穿刺处血肿等其他并发症。随访期间1例患者出现再狭窄及临床症状予再次腔内治疗后好转。结论腔内治疗是解决锁骨下动脉狭窄和闭塞病变的一种安全有效的方法 ,具有创伤小、恢复快,成功率高、并发症少、远期通畅率高等优点,可作为该疾病的首选治疗方式,但需严格把握适应证。

Objective To investigate feasibility and safety of intracavitary therapy for subclavian artery stenosis and occlusion lesions. Methods A retrospective analysis was made on data of intracavitary therapy for 20 patients with subclavian artery stenosis and occlusion lesions. Patients received preoperative examination by carotid artery ultrasound, head and neck CT angiography（CTA） and transcranial color Doppler（TCD）, followed by digital subtraction angiography（DSA） and intracavitary therapy. Postoperative follow-up lasted for 1~26 months to observe clinical effects. Results There were 19 cases with successful operation of subclavian artery stentassisted angioplasty, including 18 cases by femoral artery approach and 1 case by femoral artery combined with brachial artery approach. They had eliminated subclavian artery stenosis and occlusion lesions, unobstructed blood flow and forward vertebral artery blood flow, along with technical success rate as 95%（19/20）. The patients had obviously improved clinical symptoms, and their postoperative upper limbs systolic blood pressure difference was 6~12 mm Hg（1 mm Hg=0.133 k Pa）, with mean pressure as（7.9±1.6） mm Hg. Their difference with that before treatment had statistical significance（t=17.68, P0.01）. There was no complication of abnormal embolization or hematoma at puncture area in perioperative period. Follow-up showed 1 case with recurrent stenosis and clinical symptoms, who was improved by second intracavitary therapy. Conclusion As a safe and effective method in treating subclavian artery stenosis and occlusion lesions, intracavitary therapy contains advantages of small incision, quick recovery, high success rate, few complications and high long-term patency rate. This method can be taken as the preferred treatment measure, while indications require strict management.