Yilmaz Saim, Sindel Timur, Lüleci Ersin
Department of Radiology, Akdeniz University School of Medicine, Arapsuyu 07070, Antalya, Turkey.
J Endovasc Ther. 2004 Apr;11(2):107-18. doi: 10.1583/03-1077.1.
To present our experience with subintimal recanalization of chronic iliac occlusions and retrospectively compare the results of this technique with those of standard intraluminal recanalization.
A retrospective review was conducted of 98 patients (91 men; mean age 61+/-10 years, range 37-77) with unilateral chronic iliac occlusions who underwent standard intraluminal recanalization or subintimal recanalization if intraluminal wire passage failed. The technical success, complications, and patency rates were statistically compared between groups.
In 59 (60%) of 98 patients, the occlusions were successfully crossed with ipsilateral intraluminal recanalization, while failure of intraluminal recanalization in the remaining 39 led to attempted subintimal recanalization (ipsilateral in 17 and antegrade-retrograde in 22). Overall, ipsilateral intraluminal recanalization was technically successful in 56 (57%) of 98 patients; subintimal recanalization was successful in 35 (90%) of 39 patients. Technical success was only 29% in 17 patients who underwent subintimal recanalization via an ipsilateral retrograde approach. During a follow of 27+/-16 months, primary and assisted primary patencies were not significantly different between the patients treated with intraluminal versus subintimal recanalization (p=0.81 and 0.64, respectively).
Subintimal recanalization is a safe and effective supplement to standard intraluminal recanalization techniques in the endovascular treatment of chronic iliac occlusions. Because of the poor outcome associated with the ipsilateral route, subintimal recanalization of these lesions should preferably be performed via a combined antegrade-retrograde approach.
介绍我们在慢性髂动脉闭塞内膜下再通方面的经验，并回顾性地将该技术的结果与标准腔内再通的结果进行比较。
对98例单侧慢性髂动脉闭塞患者（91例男性；平均年龄61±10岁，范围37 - 77岁）进行回顾性研究，这些患者接受了标准腔内再通术，若腔内导丝通过失败则进行内膜下再通术。对两组之间的技术成功率、并发症和通畅率进行统计学比较。
98例患者中有59例（60%）通过同侧腔内再通成功穿过闭塞段，其余39例腔内再通失败导致尝试内膜下再通（17例为同侧，22例为顺行 - 逆行）。总体而言，98例患者中有56例（57%）同侧腔内再通在技术上成功；39例患者中有35例（90%）内膜下再通成功。17例通过同侧逆行途径进行内膜下再通的患者技术成功率仅为29%。在27±16个月的随访期间，腔内再通与内膜下再通治疗的患者之间，初次通畅率和辅助初次通畅率无显著差异（分别为p = 0.81和0.64）。
在内膜下再通是慢性髂动脉闭塞血管内治疗中标准腔内再通技术的一种安全有效的补充。由于同侧途径相关的不良结果，这些病变的内膜下再通最好通过顺行 - 逆行联合途径进行。
