两种不同入路介入术治疗锁骨下动脉闭塞的远期效果对比

Comparison of Long-term Efficacy of Two Different Approaches in Interventional Therapy of Subclavian Artery Occlusion

目的:对比分析经股动脉顺行与经桡动脉逆行入路介入术治疗锁骨下动脉闭塞的远期效果。方法:回顾性分析钟祥市人民医院2017年10月-2019年3月收治的103例锁骨下动脉闭塞患者的临床病例资料及随访记录,按照不同治疗方式分为股动脉组(n=61,经股动脉顺行入路介入术治疗)和桡动脉组(n=42,经桡动脉逆行入路介入术治疗)。比较两组术后3年内1期通畅率、双上肢收缩压差值、生活质量、手术并发症及不良事件发生率。结果:两组术后3年内1期通畅率比较差异无统计学意义(P>0.05);与术前比,两组术后6个月和术后1、2、3年双上肢收缩压差值均降低(P<0.05);桡动脉组手术并发症总发生率低于股动脉组(P<0.05);桡动脉组术后3年身体机能、社会功能及精力评分均高于股动脉组(P<0.05);两组不良事件发生率比较,差异均无统计学意义(P>0.05)。结论:经股动脉顺行与经桡动脉逆行入路介入术均可有效治疗锁骨下动脉闭塞患者,而桡动脉逆行入路能明显提高患者远期生活质量,降低血管通路并发症发生率。

Objective:To compare and analyze the long-term efficacy of transfemoral artery anterograde approach and transradial retrograde approach for interventional therapy on subclavian artery occlusion.Method:The clinical case data and follow-up records of 103 patients with subclavian artery occlusion treated in Zhongxiang People’s Hospital were retrospectively analyzed between October 2017 and March 2019,and they were divided into femoral artery group (n=61,transfemoral artery anterograde approach for interventional therapy) and radial artery group (n=42,transradial retrograde approach for interventional therapy) according to different treatment methods.The first-stage patency rate within 3 years after surgery,systolic blood pressure difference of both upper limbs,quality of life,surgical complications and incidence rates of adverse events were compared between the two groups.Result:There was no statistical significance in the first-stage patency rate between the two groups within 3 years after surgery (P>0.05).Compared with before surgery,the systolic blood pressure differences of both upper limbs in both groups were decreased 6 months after surgery and 1 year,2,3 years after surgery (P<0.05).The total incidence rate of surgical complications in radial artery group was lower than that in femoral artery group (P<0.05).The scores of physical function,social function and energy at 3 years after surgery in radial artery group were higher than those in femoral artery group (P<0.05).There was no significant difference in the incidence of adverse events between the two groups (P>0.05).Conclusion:Transfemoral artery antegrade approach and transradial artery retrograde approach for interventional therapy can effectively treat patients with subclavian artery occlusion,and radial artery retrograde approach can significantly improve the long-term quality of life,reduce the incidence rates of vascular access complications.