Murphy Timothy P, Ariaratnam Nikki S, Carney Wilfred I, Marcaccio Edward J, Slaiby Jeffrey M, Soares Gregory M, Kim H Myra
Division of Vascular and Interventional Radiology, Department of Diagnostic Imaging, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903, USA.
Radiology. 2004 Apr;231(1):243-9. doi: 10.1148/radiol.2311030408. Epub 2004 Feb 19.
To establish and report the authors' experience with the long-term outcomes of aortoiliac stent placement for treatment of chronic lower-extremity ischemia.
Stents were placed in 505 arterial segment lesions in 365 patients who presented with symptoms of chronic leg ischemia between February 1992 and March 2001. The 505 treated lesions were 88 occlusions and 417 stenoses. Indications for stent placement were claudication in 312 (62%), rest pain in 107 (21%), ulcer in 67 (13%), and gangrene in 19 (4%) arterial segments. Patients were followed up for up to 105 months (mean, 33 months +/- 27 [SD]).
Hemodynamic success was achieved in 484 (98%) of the 496 limbs for which postprocedural translesion pressure gradients were available. Mean ankle-brachial indexes improved from 0.53 +/- 0.25 to 0.79 +/- 0.23 (P <.001). Major complications were seen in 24 (7%) patients. Two patients (0.5%) died within 30 days after stent placement. Twenty (6%) of 355 patients underwent aortic or iliac bypass surgery during the follow-up period. Eight years after stent placement, primary patency was 74%; primary assisted patency, 81%; and secondary patency, 84%. Variables associated with better patency included stenosis (rather than occlusion), shorter lesion length, older age, and limb-threatening ischemia. At the last follow-up examination, 74% of the 466 limbs for which follow-up clinical status data were available were asymptomatic, 22% were associated with claudication, 3% were associated with rest pain, and 1% were associated with ischemic tissue loss. Five patients underwent amputation on the ipsilateral side after stent placement.
Findings from long-term experience with aortoiliac stent placement for treatment of chronic lower-extremity ischemia confirmed the procedure to be a durable, low-risk revascularization option.
阐述并报告作者在采用主髂动脉支架置入术治疗慢性下肢缺血方面的长期疗效经验。
1992年2月至2001年3月期间，对365例有慢性腿部缺血症状的患者的505处动脉节段病变置入支架。这505处接受治疗的病变包括88处闭塞和417处狭窄。支架置入的指征为312处（62%）间歇性跛行、107处（21%）静息痛、67处（13%）溃疡以及19处（4%）动脉节段坏疽。对患者进行了长达105个月的随访（平均33个月±27[标准差]）。
在496条术后可获得跨病变压力梯度的肢体中，484条（98%）取得了血流动力学成功。平均踝肱指数从0.53±0.25提高到0.79±0.23（P<.001）。24例（7%）患者出现了主要并发症。2例患者（0.5%）在支架置入后30天内死亡。355例患者中有20例（6%）在随访期间接受了主动脉或髂动脉搭桥手术。支架置入8年后，原发性通畅率为74%；原发性辅助通畅率为81%；继发性通畅率为84%。与更好的通畅率相关的变量包括狭窄（而非闭塞）、病变长度较短、年龄较大以及肢体威胁性缺血。在最后一次随访检查时，在可获得随访临床状态数据的466条肢体中，74%无症状，22%与间歇性跛行有关，3%与静息痛有关，1%与缺血性组织丢失有关。5例患者在支架置入后对同侧进行了截肢。
主髂动脉支架置入术治疗慢性下肢缺血的长期经验结果证实该手术是一种持久、低风险的血管重建选择。
