Department of Surgery, Division of Vascular Surgery, Atrium Medical Centre, Heerlen, The Netherlands.
Eur J Vasc Endovasc Surg. 2013 Nov;46(5):583-7. doi: 10.1016/j.ejvs.2013.08.011. Epub 2013 Sep 3.
Chronic renal insufficiency (CRI) is a growing global problem. PTA can be performed without nephrotoxic contrast, utilizing Doppler-ultrasound (Duplex) guidance. Duplex-guided infra-inguinal interventions and access-related interventions have been reported. Duplex-guided iliac interventions have not been performed to any extent because of the anatomic location. In our study we evaluated the safety and efficacy of Duplex-guided percutaneous transluminal angioplasty (DuPTA) in iliac arteries.
From June 2012 until February 2013, 31 patients (35 iliac lesions), underwent DuPTA. Indications ranged from Rutherford 3 to 5. Preoperative evaluation included Ankle Brachial Index (ABI), Duplex and MRA. Procedural success was defined as crossing the lesion with a guidewire and dilating or stenting the lesion. Clinical success was defined as 50% reduction in peak systolic velocity (PSV) or clinical improvement. PSV was evaluated after PTA, then at 2 weeks. Clinical results were assessed 2 weeks after the procedure.
Procedural success was achieved in 94% of patients (33/35), all of whom also had clinical success. Post-procedural PSV reduction showed an average improvement of 63% (431 cm/s to 153 cm/s). Mean preoperative ABI was 0.72 and improved to 0.88 postoperatively.
PTA using Duplex-guidance in significant iliac stenosis is a safe method with major advantages in patients at high risk for developing contrast-induced nephropathy.
慢性肾功能不全（CRI）是一个日益严重的全球性问题。经皮腔内血管成形术（PTA）可以在不使用肾毒性造影剂的情况下进行，利用多普勒超声（双功）引导。已经报道了双功引导的下肢动脉腔内干预和通路相关干预。由于解剖位置的原因，双功引导的髂动脉干预尚未进行到任何程度。在我们的研究中，我们评估了双功引导经皮腔内血管成形术（DuPTA）在髂动脉中的安全性和有效性。
从 2012 年 6 月至 2013 年 2 月，31 名患者（35 条髂动脉病变）接受了 DuPTA。适应证范围从 Rutherford 3 级到 5 级。术前评估包括踝肱指数（ABI）、双功超声和 MRA。手术成功定义为导丝穿过病变并扩张或支架置入病变。临床成功定义为收缩期峰值流速（PSV）降低 50%或临床改善。PTA 后评估 PSV，然后在 2 周时评估。术后 2 周评估临床结果。
94%的患者（33/35）达到了手术成功，所有患者也都达到了临床成功。术后 PSV 降低显示平均改善 63%（431cm/s 至 153cm/s）。术前平均 ABI 为 0.72，术后提高至 0.88。
在有发生对比剂肾病高风险的患者中，使用双功引导的 PTA 治疗髂动脉严重狭窄是一种安全的方法，具有显著优势。
