Sohgawa Etsuji, Sakai Yukimasa, Nango Mineyoshi, Cho Hisayuki, Jogo Atsushi, Hamamoto Shinichi, Yamamoto Akira, Miki Yukio
Osaka City Med J. 2015 Jun;61(1):1-8.
Focal stenosis or occlusion of the infrarenal aorta is rare, and treatment is usually conventional bypass or endarterectomy. However, endovascular treatment has advanced in recent years. The purpose of this retrospective study is to report the results of primary stenting for focal infrarenal aortic occlusive disease and clarify the usefulness of endovascular treatment.
This study includes 6 consecutive patients (3 men, 3 women; mean age, 59.3 years) with infrarenal aortic stenosis or occlusion who underwent endovascular intervention at our hospital between April 2009 and February 2014. All patients had bilateral intermittent claudication. The mean preoperative ankle-brachial index (ABI) showed a slight to moderate decrease: right 0.668 and left 0.636. The mean lesion site length was 12.5 mm, the percent stenosis was 90.7%, and calcification was present in 3 patients. Primary stenting was performed in all patients. The stent selected was generally a self-expanding stent (SES). For patients with severe calcification, the stent selected was a balloon-expandable stent (BES).
Four patients received an SES and two patients received a BES. The technical success rate was 100%, no complications occurred, and the mean pressure gradient disappeared or decreased. Symptoms resolved in all patients and the postoperative ABI improved: right 0.923 and left 0.968. During a mean follow-up period of 27 months, there were no recurrent symptoms and no restenosis on CT angiography.
Endovascular treatment should be considered as a first line treatment for focal infrarenal aortic stenosis and occlusion.
肾下腹主动脉局灶性狭窄或闭塞较为罕见，治疗方法通常为传统搭桥术或动脉内膜切除术。然而，近年来血管内治疗取得了进展。本回顾性研究的目的是报告肾下腹主动脉局灶性闭塞性疾病初次支架置入的结果，并阐明血管内治疗的有效性。
本研究纳入了2009年4月至2014年2月期间在我院接受血管内介入治疗的6例连续性肾下腹主动脉狭窄或闭塞患者（3例男性，3例女性；平均年龄59.3岁）。所有患者均有双侧间歇性跛行。术前平均踝肱指数（ABI）呈轻度至中度降低：右侧为0.668，左侧为0.636。平均病变部位长度为12.5mm，狭窄百分比为90.7%，3例患者存在钙化。所有患者均进行了初次支架置入。所选支架一般为自膨式支架（SES）。对于钙化严重的患者，所选支架为球囊扩张式支架（BES）。
4例患者接受了SES，2例患者接受了BES。技术成功率为100%，未发生并发症，平均压力梯度消失或降低。所有患者症状均缓解，术后ABI改善：右侧为0.923，左侧为0.968。在平均27个月的随访期内，无复发症状，CT血管造影显示无再狭窄。
血管内治疗应被视为肾下腹主动脉局灶性狭窄和闭塞的一线治疗方法。
