Cotroneo Antonio Raffaele, Iezzi Roberto, Quinto Fabio, Nessi Franco, Marano Giuseppe
Department of Clinical Science and Bioimaging, section of Radiology, University G D'Annunzio, Osp SS Annunziata, Via dei Vestini, 66013 Chieti, Italy.
J Vasc Interv Radiol. 2007 Jan;18(1 Pt 1):25-30. doi: 10.1016/j.jvir.2006.10.006.
To evaluate the feasibility and effectiveness of primary stent placement for treating distal anastomotic infragenicular bypass stenoses in terms of technical success and middle-term (2-year) patency rates.
Twenty-one patients underwent primary stent placement for the treatment of distal anastomotic stenoses after infragenicular bypasses. Patients underwent clinical and color flow and duplex Doppler ultrasonographic (US) examinations 1, 3, 6, and 12 months after the endovascular procedure and every year thereafter if no complications occurred. Angiography was performed in patients with positive findings at the clinical and US examinations to evaluate the need for repeat endovascular and/or surgical treatment. The mean follow-up was 18.3 months (range, 2-30 months).
Twenty-two clinically significant (>50%) distal anastomotic stenoses were detected in 22 infragenicular grafts created in the 21 patients. The median time between endovascular treatment and surgery was 7.5 months (range, 3-18 months). The mean stenosis length was 1.4 cm (range, 0.8-2.4 cm). Twenty-four stents were implanted, two of which were used to treat restenosis immediately below the previously implanted stent. The technical success rate was 100%. No complications occurred during any of the treatments, and no periprocedural major events or complications were registered. At follow-up, the cumulative primary, primary assisted, and secondary patency rates for the treated graft stenoses were 95%, 95%, and 100%, respectively, at 6 months; 71%, 81%, and 86% at 1 year; and 71%, 76%, and 81% at 2 years. The limb salvage rate was 88%.
Although this study was limited to a small number of patients, stent placement seems to be a feasible and effective tool in the endovascular treatment of distal anastomotic infragenicular bypass graft stenoses.
从技术成功率和中期（2年）通畅率方面评估初次支架置入治疗膝下旁路移植血管远端吻合口狭窄的可行性和有效性。
21例患者在膝下旁路移植术后接受初次支架置入以治疗远端吻合口狭窄。患者在血管腔内治疗后1、3、6和12个月接受临床、彩色血流和双功多普勒超声（US）检查，若未发生并发症，则此后每年检查一次。临床和US检查结果阳性的患者进行血管造影，以评估是否需要重复血管腔内治疗和/或手术治疗。平均随访时间为18.3个月（范围2 - 30个月）。
在21例患者所构建的22条膝下移植血管中检测到22处具有临床意义（>50%）的远端吻合口狭窄。血管腔内治疗与手术之间的中位时间为7.5个月（范围3 - 18个月）。平均狭窄长度为1.4 cm（范围0.8 - 2.4 cm）。共植入24枚支架，其中2枚用于治疗先前植入支架下方紧邻部位的再狭窄。技术成功率为100%。所有治疗过程中均未发生并发症，也未记录到围手术期重大事件或并发症。随访时，治疗的移植血管狭窄的累积初次通畅率、初次辅助通畅率和二次通畅率在6个月时分别为95%、95%和100%；1年时分别为71%、81%和86%；2年时分别为71%·、76%和81%。肢体挽救率为88%。
尽管本研究限于少数患者，但支架置入似乎是血管腔内治疗膝下旁路移植血管远端吻合口狭窄可行且有效的工具。
