主髂动脉闭塞病变(TASC D级)腔内治疗的治疗效果评价

Efficacy and safety of endovascular therapy in complicated aortoiliac occlusive diseases(TASC D)

目的探讨主髂动脉闭塞病变(TASC D型)腔内治疗的安全性及治疗效果评价。方法回顾性分析辽宁省人民医院2005年1月至2015年6月51例成功接受腔内治疗的主髂动脉闭塞症患者资料,男性35例,女性16例,年龄为51~85岁,平均年龄为(61±11)岁。术前评估均适宜选用血管腔内治疗。手术经股动脉或肱动脉入路,针对病变段血管进行球囊扩张和支架置入等腔内治疗。结果所有患者闭塞段血管长度为4.8~20.6 cm,平均为(13.8±2.2)cm,未能开通闭塞段2例,手术即刻开通率为96.6%。48例(94.1%)患者临床症状明显,术后平均踝肱指数为(0.82±0.22),明显高于术前(0.35±0.06),差异有统计学意义(P<0.01)。术后随访6~63个月,平均随访时间为(32.6±10.4)个月。术后1年、3年、5年的原发通畅率分别为88.4%、83.6%、70.2%,总体生存率分别为96.1%、96.1%、82.4%。结论对于主髂动脉闭塞病变(TASC D型),以腔内治疗为主要手段的综合治疗是一项安全有效的治疗手段,可获得较满意的临床治疗效果。

Objective To evulate the safety and efficacy of endovascular therapy in complicated aortoiliac occlusive diseases. Methods A retrospective analysis of 51 cases' clinical materials who accepted endovascular therapy successfully from January 2005 to June 2015 in the People's Hospital of Liaoning Province of was made, including 35 males and 16 females, average age was 51-85 years old which mean age was(61 ± 11). Preoperative evaluation of all cases were appropriate to endovascular therapy. Through the femoral artery or brachial artery, we used PTA and stent vascular lesions segment. Results Lesions length were 4.8-20.6 cm, average was(13.8 ± 2.2) cm, surgical success rate was 96.6%. 48 cases(94.1%) patients clinical symptoms disappearred obviously. The mean postoperative ankle-brachial index was(0.82 ± 0.22), significantly higher than the preoperative(0.35 ± 0.06). The difference was statistically significant(P <0.01). Postoperative patients were followed up for 6 to 53 months, with an average followup time was(32.6 ± 10.4) months. After therapy, 1-year, 3-year and 5-year primary patency rate were 88.4%, 83.6%, 70.2%. Respectively overall survival rates were 96.1%, 96.1%, 82.4%. Conclusion For high-risk complicated aortoiliac occlusive patients, endovascular therapy was considered to be a primary means, with high safety and efficacy. Clinical outcomes would be satisfactory.