锁骨下动脉闭塞复杂型病变腔内治疗的研究

Clinical strategy of intracavitary therapy for complicated total occlusion of subclavian artery

目的分析锁骨下动脉闭塞复杂型病变的治疗结果,研究锁骨下动脉病变特点与外科治疗策略的关系。方法统计188例锁骨下动脉近端完全性闭塞患者资料,探讨锁骨下动脉复杂病变特点与治疗成功率关系及右侧病变采取脑保护伞等。结果患者治疗总成功率为70.75%,左侧成功率为76.36%,右侧成功率为50.0%。12个月的通畅率是98.2%,3年为91.2%,5年为83.8%。病变长度与腔内治疗成功率有关(χ^2=4.89,P<0.05)。且长段病变(>3 cm)治疗成功率降低(χ^2=21.27,P<0.05);病变形态与腔内治疗成功率有关(χ^2=11.01,P<0.05),处理右侧闭塞病变应用颈动脉保护伞可防止脑栓塞。结论闭塞较短、位置及形态较好的病变应首选腔内治疗,而长段及严重钙化的起始部病变,旁路手术优先选择,腔内处理右侧闭塞病变应用颈动脉保护伞预防脑栓塞的方案更安全。

Objective To investigate the clinical strategy of intracavitary therapy for complicated total occlusion of the subclavian artery.Methods The clinical data about 188 patients with total occlusion of subclavian artery proximal end who underwent intracavitary therapy in our hospital were analyzed to investjgate the pathological characteristics of complicated total occlusion of subclavian artery and their correlation with treatment success rate.Results The total treatment success rate was 70.75%,and the left side lesion success rate was 76.36%,and right side lesion success rate was 50.0%.And the 12-month patency rate was 98.2%,3-year patency rate was 92.1%,and 5-year patency rate was 83.8%.Moreover the success rate of lesion was correlated with the lesion length(P<0.05),and the success rate in longer segment lesion(>3cm)was lower(P<0.05),and pathological change types were related with the success rate(P<0.05).In addition to use carotid artery protective umbrella to treat right side lesion could prevent cerebral embolism.Conclusion The intracavitary therapy can be regarded as the first choice for total occlusion lesions of carotid artery protecti with shorter length,satisfying location and form,otherwiser,the bypass surgery maybe the better choice.Moreover the carotid artery protective umbrella is safer for treating right occlusion.