外周旁路狭窄的经皮腔内血管成形术。

Percutaneous transluminal angioplasty of peripheral bypass stenoses.

作者信息

Hoksbergen A W, Legemate D A, Reekers J A, Ubbink D T, Jacobs M J

机构信息

Department of Vascular Surgery, G1-244, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.

出版信息

Cardiovasc Intervent Radiol. 1999 Jul-Aug;22(4):282-6. doi: 10.1007/s002709900389.

DOI:10.1007/s002709900389

PMID:10415216

Abstract

PURPOSE

To assess the success of percutaneous transluminal angioplasty (PTA) in treating peripheral bypass stenoses.

METHODS

Patients who received a femoropopliteal or femorocrural bypass graft for limb ischemia were included in a duplex surveillance program. If duplex ultrasound revealed a short (<2 cm) severe (peak systolic velocity ratio >/= 4.5) stenosis, patients were scheduled for arteriography and PTA. Fifty-eight peripheral bypass stenoses in 39 grafts in 37 patients were treated with PTA. The cumulative primary patency of treated stenoses was calculated.

RESULTS

During the first year after PTA 31 (53%) treated lesions remained patent, 15 (26%) lesions restenosed at a median interval of 5.0 (range 1-12) months and 4 (7%) bypasses occluded. The cumulative primary patency of 58 treated graft stenoses at 1 year was 60% [95% confidence interval (CI) 46%-74%] and 55% (95% CI 41%-70%) at 2 years. Graft body stenoses showed a better 2-year cumulative primary patency (86%; 95% CI 68%-100%) compared with juxta-anastomotic lesions (45%; 95% CI 29%-62%; p < 0.05).

CONCLUSION

PTA is justifiable as the initial treatment of peripheral bypass stenoses. Nevertheless, the restenosis rate is rather high, especially in juxta-anastomotic lesions. Continuation of duplex surveillance after PTA and timely reintervention is recommended.

摘要

目的

评估经皮腔内血管成形术（PTA）治疗周围血管搭桥狭窄的成功率。

方法

因肢体缺血接受股腘或股胫旁路移植术的患者纳入双功超声监测项目。如果双功超声显示短段（<2 cm）严重狭窄（收缩期峰值流速比≥4.5），患者安排行动脉造影和PTA。对37例患者39条移植血管中的58处周围血管搭桥狭窄进行了PTA治疗。计算治疗狭窄的累积原发性通畅率。

结果

PTA术后第1年，31处（53%）治疗病变保持通畅，15处（26%）病变在中位间隔5.0个月（范围1 - 12个月）时再狭窄，4条（7%）旁路闭塞。58处治疗的移植血管狭窄1年时的累积原发性通畅率为60%[95%置信区间（CI）46% - 74%]，2年时为55%（95% CI 41% - 70%）。与吻合口旁病变（45%；95% CI 29% - 62%；p < 0.05）相比，移植血管体部狭窄的2年累积原发性通畅率更好（86%；95% CI 68% - 100%）。