Gao Peixian, Li Changliang, Wu Xuejun, Li Gang, Dong Dianning, Qi Jiaxin
Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, China.
Department of Hepatobiliary and Vascular Surgery, Zaozhuang Municipal Hospital, Zaozhuang, China.
Vascular. 2022 Jun;30(3):509-517. doi: 10.1177/17085381211023229. Epub 2021 Jun 10.
To evaluate the safety and efficacy of transbrachial and transfemoral approaches combined with visceral protection for the endovascular treatment of juxtarenal aortoiliac occlusive disease (AIOD) over an average 19-month follow-up period.
In this retrospective analysis, all patients with juxtarenal AIOD at a single institution were reviewed from June 2015 to January 2020. Patient characteristics, angiographic results, and follow-up outcomes were retrospectively recorded. The indications for treatment were critical limb threatening ischemia in 12 patients and bilateral claudication in five patients. Percutaneous access via the left brachial artery was first obtained to recanalize the infrarenal occluded lesions. After that, femoral accesses were achieved. A 4-Fr catheter, a 4 mm balloon, or a 6-Fr 90-cm-long sheath was used to complete visceral artery protection.
A total of 17 juxtarenal AIOD patients (14 males; mean age, 63.4 ± 8.1 years) underwent endovascular treatment. The technical success rate was 100%. Complete reconstruction was achieved in 15 (88.2%) patients. The infrarenal aorta was reconstructed with kissing covered stent grafts ( = 7), kissing bare-metal stents ( = 2), covered stent grafts ( = 2), bare-metal stents ( = 1), or the off-label use of iliac limb stent grafts ( = 5). Renal embolization was found in 3 (17.6%) patients during intraoperative angiography. There was 1 (5.9%) case of distal runoff embolization after CDT and 1 (5.9%) case of left iliac artery rupture. One (5.9%) death occurred due to acute myocardial infarction 20 days after the operation. The average follow-up period was 19.3 ± 16.7 months (range, 1-54 months) in the remaining 16 cases. The renal artery patency rate was 100%. The estimated cumulative primary patency rates were 92.3% at 12 months and 59.3% at 36 months according to the Kaplan-Meier method.
Transbrachial and transfemoral approaches combined with visceral protection offer a safe and effective alternative to open revascularization for the endovascular treatment of juxtarenal AIOD.
评估经肱动脉和股动脉入路联合内脏保护技术在肾动脉水平腹主动脉-髂动脉闭塞性疾病（AIOD）血管内治疗中的安全性和有效性，随访期平均为19个月。
在这项回顾性分析中，对2015年6月至2020年1月期间单中心的所有肾动脉水平AIOD患者进行了评估。回顾性记录患者的特征、血管造影结果和随访结果。治疗指征为12例患者存在肢体严重缺血，5例患者存在双侧间歇性跛行。首先经左肱动脉穿刺，对肾下闭塞病变进行再通。之后，建立股动脉入路。使用4F导管、4mm球囊或6F 90cm长的鞘管完成内脏动脉保护。
共有17例肾动脉水平AIOD患者（14例男性；平均年龄63.4±8.1岁）接受了血管内治疗。技术成功率为100%。15例（88.2%）患者实现了完全重建。肾下腹主动脉重建采用吻合法覆膜支架（n = 7）、吻合法裸金属支架（n = 2）、覆膜支架（n = 2）、裸金属支架（n = 1）或违规使用髂支覆膜支架（n = 5）。术中血管造影发现3例（17.6%）患者发生肾动脉栓塞。1例（5.9%）患者在导管溶栓（CDT）后发生远端血流栓塞，1例（5.9%）患者发生左髂动脉破裂。1例（5.9%）患者术后20天因急性心肌梗死死亡。其余16例患者的平均随访期为19.3±16.7个月（范围1-54个月）。肾动脉通畅率为100%。根据Kaplan-Meier法，估计12个月时的累计原发性通畅率为92.3%，36个月时为59.3%。
经肱动脉和股动脉入路联合内脏保护技术为肾动脉水平AIOD的血管内治疗提供了一种安全有效的替代开放血管重建的方法。
