Gülcü Aytaç, Gezer Naciye Sinem, Akar Servet, Akkoç Nurullah, Önen Fatoş, Göktay Ahmet Yiğit
Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey.
Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey.
Ann Vasc Surg. 2017 Jul;42:93-100. doi: 10.1016/j.avsg.2016.10.066. Epub 2017 Mar 18.
This retrospective study evaluated the long-term results of endovascular repair in the management of arterial stenosis caused by Takayasu's arteritis (TA).
Sixty-seven endovascular procedures (percutaneous transluminal balloon angioplasty or stenting) were performed for 49 arterial lesions in 35 patients. Endovascular treatment was performed when the disease was inactive. The patients were pretreated with immunosuppressive drugs and were followed every 3-6 months to monitor disease activity and medical treatment. Doppler ultrasonography and magnetic resonance angiography were performed every 6 months. Kaplan-Meier method with the log-rank test was used to analyze the survival of renal artery procedures because the number of lesions in other territories was not sufficient for statistical analysis. The mean follow-up duration after the endovascular procedure was 83 months (range: 12-144 months).
Twenty-two (33%) endovascular interventions resulted in restenosis or occlusion. Reinterventions resulted in primary assisted patency in 45 (92%) lesions with restenosis. Only 4 (8%) of the 49 arterial lesions were occluded at the time of the final evaluation. The overall patency rate for the renal artery stents was 93.7% (15/16) after 8 years of follow-up. In the Kaplan-Meier survival analyses of the renal artery lesions, the 1- and 8-year restenosis-free survival rates of renal arterial interventions were 74% and 57%, respectively, (P = 0.281).
In this study, endovascular treatment with adequate immunosuppressive medication resulted in long-term patency with one- or multi-stage reinterventions in 92% of stenotic arterial lesions caused by TA.
本回顾性研究评估了血管内修复术治疗高安动脉炎（TA）所致动脉狭窄的长期效果。
对35例患者的49处动脉病变进行了67次血管内手术（经皮腔内球囊血管成形术或支架置入术）。在疾病静止期进行血管内治疗。患者术前接受免疫抑制药物治疗，并每3 - 6个月随访一次，以监测疾病活动度和药物治疗情况。每6个月进行一次多普勒超声检查和磁共振血管造影。由于其他部位病变数量不足以进行统计分析，故采用Kaplan - Meier法和对数秩检验分析肾动脉手术的生存率。血管内手术后的平均随访时间为83个月（范围：12 - 144个月）。
22例（33%）血管内干预导致再狭窄或闭塞。再次干预使45例（92%）发生再狭窄的病变获得了初次辅助通畅。在最终评估时，49处动脉病变中仅有4例（8%）闭塞。肾动脉支架随访8年后的总体通畅率为93.7%（15/16）。在肾动脉病变的Kaplan - Meier生存分析中，肾动脉干预的1年和8年无再狭窄生存率分别为74%和57%（P = 0.281）。
在本研究中，采用适当免疫抑制药物的血管内治疗使TA所致92%的狭窄性动脉病变通过一期或多期再次干预实现了长期通畅。
