下肢动脉支架变形断裂的原因分析及应对策略

The Analysis on Reasons and Coping Strategies of Arterial Stents Deformation and Fracture in Lower Extremity

目的:探讨下肢动脉支架植入术后支架变形断裂的原因及处理方法。方法:回顾性分析自2013年1月1日至2017年12月31日209例通过血管支架植入术治疗下肢动脉硬化性闭塞症患者的病例资料。根据患者影像学资料及手术记录,归纳分析下肢动脉支架发生变形断裂的部位、时间、支架类型、原因及处理方法等。结果:80例髂动脉病变中1例出现支架变形断裂,支架内急性血栓形成,6个月支架变形断裂率为1.25%,之后随访未有增加;129例股腘动脉病变中有12例患者出现支架变形断裂,随访6个月支架断裂率为3.88%,1年支架断裂率为6.2%,2年支架断裂率为9.3%。统计显示髂动脉组与股腘动脉组支架断裂率比较存在统计学意义(P<0.05),支架长度大于150mm组与支架长度小于150mm组间支架断裂率比较存在统计学意义(P<0.05)。结论:下肢动脉支架变形断裂主要与支架植入位置、支架长度有关、亦和外力作用、支架本身缺陷等因素相关;与支架植入数量、病变血管闭塞长度、钙化严重程度、性别及年龄等无关;处理办法主要包括置管溶栓、球囊扩张、再次支架植入等治疗。

Objective:To investigated the reasons of arterial stents deformation and fracture in lower extremity and explore the management strategies.Methods:The clinical data of 209 cases who received arterial stenting in lower extremity from January 1,2013 to December 31,2017 were reviewed retrospectively.All cases underwent imaging studies including CTA or DSA,collecting the data from imaging and surgical records.Summarized the characteristics of lower extremity arterial stent deformation and fracture,analyzed the lesions,the locations,the time,the stent types,causes of stent deformation and fracture,treatment methods.Results:One patient presented stent deformation and fracture with acute thrombosis 7 days after stent implantation,the rate of stent fracture at 6 months was 1.25%,and there was no increase in follow-up for two years;There were twelve cases of stent fracture in 129 patients with femoral popliteal artery stent implantation;The stent fracture rate was 3.88%for 6 months,6.2%for 1 year and 9.3%for 2 years.There was statistical difference in the stent fracture rate between the iliac artery group and the femoral popliteal artery group(P<0.05),the comparison of stent fracture rate between the stent length greater than 150 mm group and stent length less than 150 mm group was statistically significant(P<0.05).Conclusion:Stent fractures of lower limb arterial are mainly related to the location,the length of the stent,relationship between stents and surrounding tissues and other factors,as well as external forces,defects of stents themselves;There was no correlation with the number of stents,length of stenosis and occlusion,severity of calcification,gender or age.Thrombolytic therapy,balloon angioplasty,and additional stenting are the main treatment methods.