右锁骨下动脉闭塞型病变治疗策略的研究

CLINICAL STUDY ON THE TREATMENT STRATEGY OF RIGHT SUBCLAVIAN ARTERY OCCLUSION

目的通过分析右锁骨下动脉闭塞型病变的临床治疗结果,研究此类特殊病变外科治疗的策略。方法回顾性分析257例锁骨下动脉近端完全性闭塞的患者资料,讨论右侧病变介入与转流手术成功率的关系。结果腔内治疗成功率低于旁路手术(70.7%vs.100%)(χ^(2)=25.68,P<0.01);并发症率(5.32%vs.8.70%)(χ^(2)=0.99,P>0.05)差异无统计学意义;介入治疗双侧成功率均低于旁路手术(χ^(2)=10.79,P<0.01;χ^(2)=22.15,P<0.01);介入治疗组左侧成功率高于右侧(76.4%vs.50%)(χ^(2)=9.33,P<0.05);旁路手术组双侧病变成功率均为100%;右侧病变腔内治疗使用颈动脉保护伞能减少神经系统并发症(χ^(2)=9.33,P<0.05);颈总-锁骨下动脉比腋-腋动脉搭桥术后效果更好(χ^(2)=4.40,P<0.05)。结论支架治疗可作为锁骨下动脉完全闭塞病变的良好方案,但处理右侧闭塞病变考虑用颈动脉保护装置更安全,否则首选颈总-锁骨下动脉旁路手术。

Objective To thorough analysis data of different treatment for subclavian artery occlusive disease, we want to find out series of surgical strategies.Methods By summarizing clinical experience of the treatment results of two hundred and fifty-seven subclavian artery occlusion lesions, we analyze and compare the relationship between bypass surgery and endovascular treatment for right occlusion.Results The success rate of interventional therapy was lower than that of bypass surgery(70.7% vs.100%)(χ^(2)=25.68,P<0.01).There was no difference in the complication rate(5.32% vs.8.70%)(χ^(2)=0.99,P>0.05).The right and left side success rate of interventional therapy was lower than that of bypass surgery(χ^(2)=10.79,P<0.01;χ^(2)=22.15,P<0.01).The success rate of the left side was higher than that of the right side in the interventional treatment group(76.4% vs.50%)(χ^(2)=9.33,P< 0.05).The success rate of bilateral lesions in the bypass group was 100%.Interventional treatment of the right lesion with carotid artery embolic protection devices could reduce neurological complications(χ^(2)=9.33,P< 0.05).Carotid-subclavian bypass can get a better job than axillary-axillary bypass arterial in hemodynamic(χ^(2)=4.40,P< 0.05).Conclusion Endovascular therapy with stent placement can be used as an effective therapy for total occlusion of the proximal subclavian artery.However, embolic protection devices should be considered during the management of right side occlusion.If not, carotid-subclavian bypass maybe the better choice for rightside.