Batt Michel, Baqué Jean, Ajmia Florian, Cavalier Maxime
Departments of 1Vascular Surgery and.
J Endovasc Ther. 2014 Jun;21(3):400-6. doi: 10.1583/13-4676R.1.
To evaluate the performance of balloon angioplasty in the treatment of superior gluteal artery (SGA) lesions and the factors influencing results.
Between April 1997 and June 2012, 217 patients were treated for disabling buttock claudication. Of these, 34 (15%) consecutive patients (30 men; mean age 70±9 years) underwent angioplasty for 44 SGA origin lesions (5 bilateral): 24 stenoses and 20 occlusions. Standardized follow-up included clinical examination at 1 and 6 months and annually thereafter; angiography or computed tomography was obtained in cases of recurrent buttock claudication.
Angioplasty was successful in 31 patients; 3 of the 20 SGA occlusions could not be recanalized. Twenty-four (59%) SGAs were treated without a stent (14 stenoses and 10 occlusions), while 10 stenoses and 7 occlusions were stented. There were no instances of SGA rupture, occlusion, or pseudoaneurysm. Two recanalizations were complicated with contrast extravasation in the buttock without consequence. Over a mean 49.8±39 months (range 1-132), 5 patients died of unrelated causes. Buttock claudication recurred in 13 (38%) patients (14 SGA lesions) at a mean 21.5±14 months (range 1-132); repeat angioplasty was successful in 8 patients. Estimates of primary and secondary freedom from symptom recurrence at 4 years were 60% and 68%, respectively. There was no difference in patency between SGAs treated for occlusion or stenosis or between those treated with or without a stent.
In this series, angioplasty has proven to be a safe and efficacious way to treat SGA lesions with disabling claudication. Repeat balloon dilation was effective in treating SGA restenosis but failed in three quarters of the reocclusions. Progress in guidewire design and optimal use has improved success with SGA occlusions.
评估球囊血管成形术治疗臀上动脉（SGA）病变的效果及影响结果的因素。
1997年4月至2012年6月期间，217例患者因致残性臀部间歇性跛行接受治疗。其中，34例（15%）连续患者（30例男性；平均年龄70±9岁）因44处SGA起始部病变（5处双侧病变）接受血管成形术：24处狭窄和20处闭塞。标准化随访包括术后1个月和6个月以及此后每年的临床检查；复发性臀部间歇性跛行患者进行血管造影或计算机断层扫描。
31例患者血管成形术成功；20处SGA闭塞中有3处未能再通。24处（59%）SGA病变治疗时未置入支架（14处狭窄和10处闭塞），而10处狭窄和7处闭塞置入了支架。未发生SGA破裂、闭塞或假性动脉瘤。2例再通术并发臀部造影剂外渗，但无不良后果。平均随访49.8±39个月（范围1 - 132个月），5例患者死于无关原因。13例（38%）患者（14处SGA病变）出现臀部间歇性跛行复发，平均复发时间为21.5±14个月（范围1 - 132个月）；8例患者再次血管成形术成功。4年时原发性和继发性症状复发自由度估计分别为60%和68%。闭塞或狭窄的SGA病变治疗后通畅率无差异，置入或未置入支架的治疗组间也无差异。
在本系列研究中，血管成形术已被证明是治疗伴有致残性间歇性跛行的SGA病变的一种安全有效的方法。重复球囊扩张术治疗SGA再狭窄有效，但四分之三的再闭塞治疗失败。导丝设计和最佳使用方面的进展提高了SGA闭塞的成功率。
