分叉型一体式覆膜支架治疗主髂动脉闭塞的疗效分析

Clinical analysis of the treatment of aortoiliac occlusive disease using unibody bifurcate endografts

目的评价分叉型一体式覆膜支架治疗主髂动脉闭塞的安全性和有效性。方法2016年3月至2017年11月青岛大学附属医院收治的临床表现为重度间歇性跛行、缺血性静息痛及非愈合性溃疡(卢瑟福分级3~5级)的主髂动脉闭塞患者,排除病变累及肾上腹主动脉、主髂动脉管壁严重钙化超过周长3/4合并管腔重度狭窄(狭窄>70%)预计支架难以撑开者,共计7例,均接受分叉型一体式覆膜支架置入治疗。对7例患者的临床资料进行回顾性分析。观察围手术期并发症发生、随访期间支架通畅、肢体截肢及症状改善状况。结果7例患者成功接受一体式分叉型覆膜支架治疗,术中无主髂动脉夹层、破裂、出血,围手术期无支架移位、血栓形成及心脑血管意外;无肢体大截肢、急性肾功能损伤。2例出现肢体肿胀,保守治疗后好转。中位随访时间11.0(6.3~21.3)个月,支架均通畅;3例卢瑟福分级降低1个等级,3例降低2个等级,1例降低3个等级。结论分叉型一体式覆膜支架治疗主髂动脉闭塞安全有效,具有理想的近中期通畅率,远期通畅率有待于进一步观察。

Objective To evaluate the safety and efficiency of the unibody bifurcate endografts in treating aortoiliac occlusive disease. Methods We performed a retrospective review of patients with aortoiliac occlusive disease who underwent endovascular revascularization with unibody bifurcated endografts. Data of demography, operative details, and outcomes were collected. Results From March 2016 to December 2017, 7 patients (6 males and 1 female) were treated using this endovascular technique. Technical success was achieved in all patients and there were no procedure related complications. The aortoiliac reconstructions remained patent within the median follow up of 11.0 (range 6.3-21.3) months, and all the patients clinically were improved an average of 1.71 Rutherford categories. Conclusions Endovascular repairment using an unibody bifurcated endograft for aortoiliac occlusive disease is feasible and effective, and has excellent short and midterm patency;however, the long-term patency need to be consequently observed.