Servicio de Angiología y Cirugía Vascular, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain.
J Endovasc Ther. 2014 Apr;21(2):223-9. doi: 10.1583/13-4443MR.1.
To report midterm outcomes for endovascular treatment of external iliac artery (EIA) occlusive disease and assess possible factors affecting patency.
A retrospective analysis was conducted of 99 consecutive patients (91 men; mean age 67.3 years) with claudication (n=70) or critical limb ischemia (n=29) owing to occlusive EIA disease treated at our center from January 2005 to June 2012. The majority of lesions (79/108) were TASC A/B. Lesions were a mean 42.2 mm long (range 10-125); 43/108 affected the distal third of the EIA. Balloon angioplasty alone was performed in 7 limbs, while the remaining 101 lesions were stented (65 self-expanding, 24 balloon-expandable, and 12 covered). Clinical and hemodynamic follow-up was performed at 1, 3, 6, and 12 months after therapy and yearly thereafter. The factors examined were procedure characteristics and patency rates.
Over a median follow-up of 27.5 months (range 1-89), there were 2 (1.9%) early occlusions followed by a successful reintervention, 4 late occlusions, and 5 hemodynamic failures followed by 7 reinterventions. These events led to primary and secondary patency rates at 30 months of 89.7% and 94.1%, respectively. No differences in patency rates were detected according to age, clinical state, or comorbidity. Use of covered stents (p=0.006) was the only variable associated with lower primary patency rates.
Endovascular therapy to treat TASC A/B lesions of the EIA yielded good short and midterm patency and low early morbidity and mortality. Lesions involving the distal third of the EIA treated by simple angioplasty ± stenting fared worse. No clinical factors could be correlated with patency.
报告血管内治疗髂外动脉（EIA）闭塞性疾病的中期结果，并评估可能影响通畅率的因素。
对 2005 年 1 月至 2012 年 6 月在我中心接受治疗的 99 例（91 例男性；平均年龄 67.3 岁）因 EIA 闭塞性疾病出现间歇性跛行（n=70）或临界肢体缺血（n=29）的连续患者进行回顾性分析。大多数病变（79/108）为 TASC A/B 型。病变长度平均为 42.2mm（范围 10-125mm）；43/108 累及 EIA 远端三分之一。7 条肢体仅行单纯球囊血管成形术，101 条病变采用支架置入（65 条自膨式，24 条球囊扩张式，12 条覆膜式）。治疗后 1、3、6 和 12 个月以及此后每年进行临床和血液动力学随访。检查的因素包括手术特点和通畅率。
中位随访 27.5 个月（范围 1-89 个月）后，2 例（1.9%）发生早期闭塞，经成功再次介入治疗后恢复通畅，4 例发生晚期闭塞，5 例发生血液动力学失败，随后进行 7 次再次介入治疗。这些事件导致 30 个月时的原发性和继发性通畅率分别为 89.7%和 94.1%。年龄、临床状态或合并症均未导致通畅率差异。覆膜支架的使用（p=0.006）是与原发性通畅率降低相关的唯一变量。
血管内治疗 TASC A/B 型 EIA 病变可获得良好的短期和中期通畅率，且早期发病率和死亡率较低。单纯血管成形术±支架置入治疗 EIA 远端三分之一病变的效果较差。无临床因素与通畅率相关。
