Nyman U, Uher P, Lindh M, Lindblad B, Ivancev K
Department of Radiology, Malmö University Hospital, University of Lund, Sweden.
Cardiovasc Intervent Radiol. 2000 Mar-Apr;23(2):97-108. doi: 10.1007/s002709910021.
To evaluate the results of primary stenting in aortic occlusive disease.
Thirty patients underwent primary stenting of focal concentric (n = 2) and complex aortic stenoses (n = 19), and aortic or aorto-iliac occlusions (n = 9). Sixteen patients underwent endovascular outflow procedures, three of whom also had distal open surgical reconstructions. Median follow-up was 16 months (range 1-60 months).
Guidewire crossing of two aorto-biiliac occlusions failed, resulting in a 93% (28/30) technical success. Major complications included one access hematoma, one myocardial infarction, one death (recurrent thromboembolism) in a patient with widespread malignancy, and one fatal hemorrhage during thrombolysis of distal emboli from a recanalized occluded iliac artery. One patient did not improve his symptoms, resulting in a 1-month clinical success of 83% (25/30). Following restenting the 26 stented survivors changed their clinical limb status to +3 (n = 17) and +2 (n = 9). During follow-up one symptomatic aortic restenosis occurred and was successfully restented.
Primary stenting of complex aortic stenoses and short occlusions is an attractive alternative to conventional surgery. Larger studies with longer follow-up and stratification of lesion morphology are warranted to define its role relative to balloon angioplasty. Stenting of aorto-biiliac occlusions is feasible but its role relative to bypass grafting remains to be defined.
评估主动脉闭塞性疾病一期支架置入的效果。
30例患者接受了局灶性同心性狭窄（n = 2）、复杂性主动脉狭窄（n = 19）以及主动脉或主-髂动脉闭塞（n = 9）的一期支架置入。16例患者接受了血管腔内流出道手术，其中3例还进行了远端开放手术重建。中位随访时间为16个月（范围1 - 60个月）。
两根主-髂动脉闭塞的导丝通过失败，技术成功率为93%（28/30）。主要并发症包括1例穿刺部位血肿、1例心肌梗死、1例广泛恶性肿瘤患者死亡（复发性血栓栓塞）以及1例再通的髂动脉闭塞远端栓子溶栓期间的致命性出血。1例患者症状未改善，1个月时临床成功率为83%（25/30）。再次支架置入后，26例支架置入存活者的临床肢体状况改善为+3（n = 17）和+2（n = 9）。随访期间发生了1例有症状的主动脉再狭窄，并成功进行了再次支架置入。
复杂性主动脉狭窄和短段闭塞的一期支架置入是传统手术的一个有吸引力的替代方法。需要进行更大规模、更长随访时间以及对病变形态进行分层的研究，以确定其相对于球囊血管成形术的作用。主-髂动脉闭塞的支架置入是可行的，但其相对于旁路移植术的作用仍有待确定。
