腔内修复术对外周血管创伤患者的中远期疗效分析

Mid-and long-term outcomes of endovascular repair in peripheral vascular trauma

目的采用腔内修复术治疗外周血管创伤患者,观察其中远期疗效。方法回顾性分析我中心2008年3月至2016年4月46例外周血管创伤患者的临床资料,其中男性34例,女性12例;年龄23~61(39.8±11.6)岁。损伤类型:动脉内膜损伤16例,动脉部分断裂11例,动脉完全断裂7例,假性动脉瘤9例,动静脉瘘3例。46例均经血管造影明确诊断,同时行腔内修复治疗。分别在术后3、6、12个月进行随访,之后每年随访1次。结果 46例患者均成功完成手术,手术成功率100%。手术时间30~90(50±16)min。腔内修复治疗后受损动脉血流恢复通畅,假性动脉瘤及动静脉瘘消失,无对比剂外溢现象。无围手术期死亡及肢体缺血坏死、感染、截肢等严重并发症。46例患者无失访,随访12~61个月,中位随访时间43.5个月。1例出现支架内血栓形成,予溶栓治疗后血流恢复;1例支架内再狭窄>50%,予球囊扩张等处理后血流恢复通畅;其余患者动脉血流保持通畅。随访期间无支架移位、断裂、内漏等并发症发生。结论腔内修复术治疗外周血管创伤中远期疗效显著。

Objective To evaluate the mid- and long-term outcomes of endovascular repair in patients with peripheral vascular trauma. Methods The clinical data of 46 patients with peripheral vascular trauma treated in our hospital from March 2008 to April 2016 were retrospectively analyzed. Among the 46 cases, 34 were males and 12 were females, at a mean age of 39.8 ± 11.6 （ranging from 23 to 61 ） years. The types of lesion were intimal injury （ n = 16）, partial transection （ n = 11 ）, complete transection （ n = 7 ）, pseudoaneurysm （n = 9 ） and arteriovenous fistula （n = 3 ）. All patients were diagnostically confirmed by angiography and underwent endovascular repair. The follow-up was at 3, 6 and 12 months postoperatively, and then once a year. Results The surgery was successful in all patients with mean operation time of 50 ± 16 （30 to 90） rain. After the operation, arterial blood flow recovered, arterial pseudoaneurysm and arteriovenous fistula disappeared, and no contrast extravasation was observed. No perioperative mortality or other severe complications such as ischemic necrosis, infection or amputation occurred. No case was lost during the follow- up of a median perivd of 43.5 （ranging from 12 to 61 ） months. During the follow-up, one patient was treated with thrombolytic therapy because of stent thrombosis, and one patient had a second balloon dilation because stent stenosis was more than 50%. All patients had recovered blood flow after treatment with no complications of stent migration, fracture or endoleak. Conclusion Endovascular repair shows favorable mid-and long-term outcomes in the treatment of peripheral vascular trauma.