锁骨下动脉近段阻塞性病变血管内治疗的长期结果。

Long-term results of endovascular therapy for proximal subclavian arterial obstructive lesions.

机构信息

Department of Vascular Surgery, Chaoyang Hospital, Capital Medical University, Beijing 100020, China.

出版信息

Chin Med J (Engl). 2010 Jan 5;123(1):45-50.

PMID:20137574

Abstract

BACKGROUND

Endovascular therapy is a treatment option for localized occlusion of the subclavian artery. In this report the long-term experience with 59 patients is presented.

METHODS

Between June 1998 and September 2008, we used endovascular therapy to treat 61 subclavian arterial obstructive lesions in 59 patients (46 males and 13 females, 34 - 82 years of age with a mean age (61.9 + or - 11.0) years). Twenty patients (34%) had clinical symptoms due to vertebrobasilar insufficiency, 26 (44%) had disabling arm ischemia, and 13 (22%) had both symptoms. We performed all procedures under local anesthesia. The approaches were from the femoral artery (n = 47), brachial artery (n = 1, involving bilateral subclavian disease) or both (n = 11). Sixty stents were implanted. All patients were followed-up at 1, 3, 6, and 12 months post-procedure, and annually thereafter.

RESULTS

We achieved technical success in 58 (95.1%) arteries, all of which were stented. There were three technical failures; two were due to the inability to cross over an occlusion, necessitating the switch to an axillo-axillary bypass, and the third was due to shock after digital subtraction angiography and prior to stenting. Arterial stenosis pre- and post-stenting was (83.6 + or - 10.8)% and (2.5 + or - 12.5)% (P < 0.01). Clinical success was achieved in 55 of the 59 patients (93.4%). Of the four clinical failures, three were technical and the remaining patient had a stent thrombosis. Systolic blood pressure difference between the two brachial arteries was (44.7 + or - 18.5) vs. (2.2 + or - 3.9) mmHg (P < 0.01). Primary patency was 98% at 12 months, 93% at 24 months, and 82% at 5 years. Five patients were lost to follow-up by 12 months post-stenting. Significant recurrent obstruction developed in five patients with resumption of clinical symptoms. The overall survival rate was 98.2% at 12 months, 89.5% at 24 months, and 84.5% at 5 years.

CONCLUSIONS

Endovascular therapy for proximal subclavian arterial obstructive lesions is effective and successful. This minimally invasive treatment may be the first choice of treatment for proximal subclavical arterial obstructive lesions.

摘要

背景

血管内治疗是治疗锁骨下动脉局限性闭塞的一种治疗选择。本报告介绍了 59 例患者的长期经验。

方法

1998 年 6 月至 2008 年 9 月，我们使用血管内治疗治疗 59 例患者（61 例锁骨下动脉阻塞性病变）中的 61 例（46 例男性和 13 例女性，年龄 34-82 岁，平均年龄 61.9+/-11.0 岁）。20 例（34%）因椎基底动脉供血不足出现临床症状，26 例（44%）因手臂缺血导致残疾，13 例（22%）同时出现上述两种症状。所有患者均在局部麻醉下进行治疗。治疗途径有经股动脉（n=47）、肱动脉（n=1，涉及双侧锁骨下动脉病变）或两者（n=11）。共植入 60 个支架。所有患者术后 1、3、6、12 个月及此后每年进行随访。

结果

58 例（95.1%）动脉达到技术成功，均植入支架。有 3 例技术失败，其中 2 例因无法跨越闭塞而转为腋-腋旁路，第 3 例因数字减影血管造影后休克而未植入支架。支架置入前后动脉狭窄率分别为（83.6+/-10.8）%和（2.5+/-12.5）%（P<0.01）。59 例患者中有 55 例（93.4%）获得临床成功。4 例临床失败中，3 例为技术失败，1 例为支架血栓形成。双侧肱动脉收缩压差值为（44.7+/-18.5）mmHg 与（2.2+/-3.9）mmHg（P<0.01）。12 个月时，初始通畅率为 98%，24 个月时为 93%，5 年时为 82%。5 例患者在支架置入后 12 个月时失访。5 例有临床症状复发的患者出现明显再阻塞。12 个月时总体生存率为 98.2%，24 个月时为 89.5%，5 年时为 84.5%。