Department of Radiology, Hull Royal Infirmary, Hull and East Yorkshire Hospitals NHS Trust, Anlaby Road, Hull, HU3 2JZ, UK.
Cardiovasc Intervent Radiol. 2013 Feb;36(1):62-8. doi: 10.1007/s00270-012-0372-6. Epub 2012 Mar 29.
The purpose of this study was to evaluate the technical success, complications, long-term clinical outcome, and patency after primary infrarenal aortic stenting for aortic and aortoiliac stenosis. Between January 1999 and January 2006, 22 consecutive patients underwent endovascular treatment because of infrarenal aortic stenosis with and without common iliac stenosis (10 men; mean age 64 ± 14 years). Eleven (11 of 22) patients had an isolated aortic stenosis, whereas 11 of 22 had aortic stenosis that extended into the common iliac arteries (CIAs). Thirteen patients were Rutherford classification type 3, and 9 patients were type 4. Statistical analysis included paired Student t test and Kaplan-Meier life table analysis; p < 0.05 was considered significant. Technical and initial clinical success was achieved in all patients. There were three (14 %) procedure-related complications, which included two access-point pseudoaneurysms and one non-flow-limiting left external iliac dissection. Patients were followed-up for a mean period of 88 months (range 60-132). Mean preprocedure ankle brachial pressure indexes (ABPI) were 0.60 ± -0.15 (right) and 0.61 ± -0.16 (left). After the procedure they were 0.86 ± -0.07 (right) and 0.90 ± -0.09 (left). The increase in ABPI was significant (p < 0.05), and this continued throughout follow-up. Four (18 %) patients had recurrence of symptoms during follow-up. These occurred at 36, 48, 48, and 50 months after the original procedure. All four patients were successfully treated with repeat angioplasty procedures. There was a significant difference in primary patency between isolated aortic stenosis (100 %) and aortoiliac stenosis (60 %) (p = 0.031). Cumulative follow-up was 1920 months yielding a reintervention rate of 0.025/events/year.
Primary stenting of infrarenal stenosis is safe and successful with a low reintervention rate. It should be considered as first-line treatment for patients with infrarenal aortic stenotic disease.
本研究旨在评估腹主动脉下段支架置入术治疗腹主动脉和主髂动脉狭窄的技术成功率、并发症、长期临床结果和通畅率。1999 年 1 月至 2006 年 1 月，22 例连续患者因腹主动脉下段狭窄合并或不合并髂总动脉狭窄而行血管内治疗（10 例男性；平均年龄 64±14 岁）。22 例患者中 11 例为单纯主动脉狭窄，22 例患者主动脉狭窄延伸至髂总动脉（CIAs）。13 例患者为 Rutherford 分级 3 级，9 例为 4 级。统计学分析包括配对学生 t 检验和 Kaplan-Meier 生存表分析；p<0.05 被认为有统计学意义。所有患者均达到技术和初始临床成功。有 3 例（14%）与操作相关的并发症，包括 2 例入路假性动脉瘤和 1 例非血流限制的左侧髂外动脉夹层。患者平均随访 88 个月（60-132 个月）。术前踝肱指数（ABI）平均值为右 0.60±-0.15，左 0.61±-0.16。术后右 0.86±-0.07，左 0.90±-0.09。ABI 升高有统计学意义（p<0.05），并持续随访。4 例（18%）患者在随访期间出现症状复发。分别发生在原始手术 36、48、48 和 50 个月后。所有 4 例患者均成功接受了重复血管成形术治疗。单纯主动脉狭窄（100%）与主髂动脉狭窄（60%）的初始通畅率有显著差异（p=0.031）。累计随访 1920 个月，再干预率为 0.025/事件/年。
腹主动脉下段狭窄的支架置入术是安全有效的，再干预率低。对于腹主动脉狭窄性疾病患者，应将其作为一线治疗方法。
