De Roeck A, Hendriks J M H, Delrue F, Lauwers P, Van Schil P, De Maeseneer M, François O, Parizel P, d'Archambeau O
Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium.
Acta Chir Belg. 2006 Mar-Apr;106(2):187-92. doi: 10.1080/00015458.2006.11679868.
To evaluate the long-term results of recanalization with primary stenting for long and complex iliac artery occlusions.
Retrospective non-randomized study.
Between 1996 and 2004, 38 patients underwent recanalization of an occluded iliac artery with subsequent stenting for TASC B lesions in 12 patients, TASC C in 10 and TASC D in 16. Thirty-one patients had Fontaine stage 2 B, four patients had stage 3 and one patient had stage 4. Two patients (5.4%) presented with acute ischemia and received trombolysis before recanalization. Patency results were calculated using Kaplan and Meier analysis. The mean follow-up was 26 months.
Technical success was 97.4%. Thirty-day mortality was 2.7%. The primary patency rate was 94%, 89% and 77% at 1, 3 and 5 years respectively. Three re-occlusions (8.1%) and one restenosis (2.7%) were observed during follow-up. The secondary patency (SP) rate was 100%, 94% and 94% after 1, 2 and 3 years. Fifteen patients underwent an associated procedure. A kissing stent procedure in three patients, a contralateral PTA of an iliac stenosis in 8, a femoro-femoral bypass in 2, a femoropopliteal bypass in 1 and an femoral endarterectomy in 2. The procedure related complication rate was 5.4%.
Long-term results of iliac recanalization are excellent without major complications if the procedure is technically successful. The endovascular procedure can be an alternative to an iliofemoral or aortobifemoral bypass in a high risk population.
评估原发性支架置入术治疗长段复杂髂动脉闭塞的长期效果。
回顾性非随机研究。
1996年至2004年间，38例患者接受了髂动脉闭塞再通术，随后对12例TASC B级病变、10例TASC C级病变和16例TASC D级病变患者进行了支架置入。31例患者为Fontaine 2 B期，4例为3期，1例为4期。2例患者（5.4%）出现急性缺血，在再通术前接受了溶栓治疗。使用Kaplan-Meier分析计算通畅结果。平均随访时间为26个月。
技术成功率为97.4%。30天死亡率为2.7%。1年、3年和5年的原发性通畅率分别为94%、89%和77%。随访期间观察到3例再闭塞（8.1%）和1例再狭窄（2.7%）。1年、2年和3年后的继发性通畅率分别为100%、94%和94%。15例患者接受了相关手术。3例患者进行了吻合法支架置入术，8例患者对髂动脉狭窄进行了对侧经皮腔内血管成形术，2例患者进行了股-股旁路移植术，1例患者进行了股-腘旁路移植术，2例患者进行了股动脉内膜切除术。手术相关并发症发生率为5.4%。
如果手术在技术上成功，髂动脉再通的长期效果良好，无重大并发症。血管内手术可作为高危人群髂股或主动脉双股旁路移植术的替代方案。
