锁骨下动脉狭窄和闭塞病变腔内治疗的临床效果

Clinical Effect of Intracavitary Therapy for Subclavian Artery Stenosis and Occlusion

目的评价锁骨下动脉狭窄和闭塞病变腔内治疗的效果及安全性。方法纳入2019年1月至2020年12月在河南省人民医院接受血管腔内治疗的26例锁骨下动脉狭窄或闭塞病变患者,男18例,女8例,其中吸烟患者14例,年龄46~85岁,平均(62.8±9.8)岁,术中行球囊扩张,选择性支架植入,评价治疗效果,记录患肢手术前后患/健侧收缩压差、狭窄程度,术中并发症及术后随访情况。结果26例患者手术成功率为96.2%(25/26),20例经股动脉入路顺行开通成功,5例患者经桡动脉入路逆行开通成功,手术时间为(97.6±56.1)min,术中76.9%(20/26)患者行支架植入。手术前后患/健肢收缩压差为[(37.5±7.4)比(5.8±2.4)]mmHg(1 mmHg=0.133 kPa),差异有统计学意义(P<0.001)。手术前后靶血管狭窄程度[90.0%(85.0%,100.0%)比10.0%(5.0%,10.0%)]差异有统计学意义(P<0.001)。随访12~24个月,所有患者术后症状及体征均明显改善甚至消失,1例患者因脑卒中死亡,2例患者复发出现锁骨下动脉支架内再狭窄。结论腔内治疗是锁骨下动脉狭窄和闭塞病变一种安全有效的治疗方法,远期效果好。

Objective To evaluate the efficacy and safety of intracavitary therapy of subclavian artery stenosis and occlusion.Methods A total of 26 patients with subclavian artery stenosis or occlusion who received intracavitary therapy in Henan Provincial People’s Hospital from January 2019 to December 2020 were included.There were 18 males and 8 females,including 14 smokers.These patients aged 46-85 years,with an average age of(62.8±9.8)years,underwent balloon dilatation and selective stent implantation during operation.The therapeutic effect was evaluated.Then the systolic pressure difference between the affected side and the uninfected side before and after operation respectively,stenosis degree before and after operation,intraoperative complications and postoperative follow-up were recorded.Results The success rate of 26 patients was 96.2%(25/26),20 patients were successfully recanalized anterograde via femoral artery,and 5 patients were successfully recanalized retrogradely via radial artery.The operation time was(97.6±56.1)minutes,and 76.9%(20/26)patients underwent stent implantation.The systolic pressure difference between the affected side and the uninfected side before and after operation was[(37.5±7.4)vs.(5.8±2.4)]mmHg(1 mmHg=0.133 kPa),the difference was statistically significant(P<0.001).The degree of target vessel stenosis before and after operation[90.0%(85.0%,100.0%)vs.10.0%(5.0%,10.0%)]was significantly different(P<0.001).After follow-up for 12-24 months,the postoperative symptoms and signs of all patients were significantly improved or even disappeared.One patient died of stroke,and two patients relapsed with subclavian artery stent restenosis.Conclusion Intracavitary therapy is a safe and effective treatment for subclavian artery stenosis and occlusion with good long-term effect.