腔内治疗主髂动脉粥样硬化闭塞症的疗效分析

Efficacy of endovascular treatment for atherosclerotic aortoiliac occlusive disease

目的探讨腔内治疗对主髂动脉粥样硬化闭塞症的临床疗效。方法收集2016年1月至2020年12月中国医学科学院阜外医院收治的153例主髂动脉闭塞症患者的临床资料,所有患者均行主髂动脉腔内介入治疗,统计其临床疗效。结果153例主髂动脉闭塞症患者中,共183条肢体行腔内治疗,其中1例患者行单纯球囊扩张术,15例患者行导管接触性溶栓(CDT)后二期支架置入术,137例患者行一期支架置入术。共49例患者行“对吻”支架置入术。技术成功率为100%。共置入支架324枚,其中覆膜支架188枚,裸支架136枚。153例主髂动脉粥样硬化闭塞症患者中,共11例患者发生腔内治疗相关并发症,其中,发生急性支架内血栓形成3例,发生穿刺相关并发症8例。共138例患者接受门诊或电话随访,随访率为90.2%(138/153),中位随访时间为24(11,46)个月。15例患者由于存在重度狭窄或闭塞导致近端继发血栓形成而接受了分期CDT+支架置入术。所有患者的临床症状均明显改善。多因素分析结果显示,年龄(HR=0.956,95%CI:0.919~0.995,P=0.026)是主髂动脉粥样硬化闭塞症患者术后免于临床症状驱动的靶病变血运重建率(fTLR)的独立危险因素。结论腔内治疗主髂动脉粥样硬化闭塞症安全、有效,具有较高的远期通畅率。

Objective To investigate the clinical effect of endovascular therapy on aortoiliac atherosclerotic occlusion(AIOD).Method The clinical data of 153 patients with AIOD admitted to Chinese Academy of Medical Sciences&Peking Union Medical College,Fuwai Hospital from January 2016 to December 2020 were collected.All patients underwent endovascular interventional treatment of the aortic iliac artery,the clinical efficacy was counted.Result Among the 153 patients with AIOD,183 limbs were treated with endovascular treatment,of which one patient underwent single balloon dilatation,15 patients underwent second-stage stent placement after catheter-directed thrombolysis(CDT),and 137 patients underwent primary stent implantation.A total of 49 patients underwent"kissing"stent placement.The technical success rate was 100%.Overall,324 stents were inserted,including 188 covered stents and 136 bare stents.Among the 153 patients with AIOD,11 patients had complications related to endovascular treatment,including 3 patients with acute in-stent thrombosis and 8 patients suffering puncture-related complications.A total of 138 patients received outpatient or telephone follow-up,the follow-up rate was 90.2%(138/153),and the median follow-up time was 24(11,46)months.Fifteen patients underwent staging CDT+stent implantation due to severe stenosis or occlusion leading to secondary thrombosis at the proximal end.The clinical symptoms of all patients were significantly improved.The results of multivariate analysis showed that age(HR=0.956,95%CI:0.919-0.995,P=0.026)was independent risk factors for postoperative freedom from clinically driven target lesion reinterventio(fTLR)in patients with AIOD.Conclusion Endovascular therapy of AIOD,which is safe and effective,has a high long-term patency rate.