Schedel Hannes, Wissgott Christian, Rademaker Juergen, Steinkamp Hermann J
Reha-Klinik, Kellberg bei Passau, Department of Radiology, Berlin, Germany.
J Vasc Interv Radiol. 2004 Apr;15(4):353-9. doi: 10.1097/01.rvi.0000121411.46920.27.
To evaluate the safety and the long-term clinical and hemodynamic results of primary stent placement of atherosclerotic calcified stenosis of the infrarenal aorta.
Between July 1996 and July 1999, 15 patients (nine male, si- female; mean age, 53.9 years) with symptomatic, calcified aortic stenosis were treated with primary stent placement. Patients underwent abdominal aortography and bilateral lower extremity arteriography. Follow-up was performed in all 15 patients. Technical success was defined as residual stenosis of less than 30% or a resting trans-systolic pressure gradient of less than 10 mm Hg after stent placement. Clinical patency was defined as the absence or improvement of symptoms after stent placement. Hemodynamic patency was defined as a normal triphasic Doppler waveform in the common femoral artery, an ankle-brachial index greater than 0.90, or the absence of a thigh-brachial pressure gradient at rest in either limb.
Technical success was achieved in 13 of 15 patients. The two patients considered to be technical failures had resting trans-systolic pressure gradients of 12 and 13 mm Hg, respectively, after stent placement. After the mean follow-up of 36 months, primary clinical and hemodynamic patency rates were 85% and the secondary hemodynamic patency rate was 100%. Two of five symptomatic recurrences during the 36-month follow-up period (range, 12-46 months) were a result of aortic restenosis and were treated with repeated percutaneous transluminal angioplasty. None of the patients required aortic surgery. Complications of the primary procedure included one puncture site infection, one pseudoaneurysm, and one distal embolization, which delayed discharge of three patients. There was no morbidity during the secondary interventions.
Primary stent placement as treatment of calcified infrarenal aortic stenosis proved to be safe and also provided durable long-term clinical improvement.
评估肾下腹主动脉粥样硬化钙化狭窄初次支架置入术的安全性以及长期临床和血流动力学结果。
1996年7月至1999年7月，对15例有症状的钙化性主动脉狭窄患者（9例男性，6例女性；平均年龄53.9岁）进行了初次支架置入治疗。患者接受了腹主动脉造影和双侧下肢动脉造影。对所有15例患者进行了随访。技术成功定义为支架置入后残余狭窄小于30%或静息跨收缩期压力梯度小于10 mmHg。临床通畅定义为支架置入后症状消失或改善。血流动力学通畅定义为股总动脉多普勒波形正常三相、踝肱指数大于0.90或任一肢体静息时大腿与肱动脉无压力梯度。
15例患者中有13例获得技术成功。2例被视为技术失败的患者在支架置入后静息跨收缩期压力梯度分别为12和13 mmHg。平均随访36个月后，初次临床和血流动力学通畅率为85%，二次血流动力学通畅率为100%。在36个月的随访期（12 - 46个月）内，5例症状复发中有2例是主动脉再狭窄所致，经重复经皮腔内血管成形术治疗。无一例患者需要进行主动脉手术。初次手术的并发症包括1例穿刺部位感染、1例假性动脉瘤和1例远端栓塞，这导致3例患者出院延迟。二次干预期间无并发症发生。
初次支架置入术治疗肾下腹主动脉钙化狭窄被证明是安全的，并且能带来持久的长期临床改善。
