Gupta A K, Ravimandalam K, Rao V R, Joseph S, Unni M, Rao A S, Neelkandhan K S
Department of Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
Cardiovasc Intervent Radiol. 1993 May-Jun;16(3):165-77. doi: 10.1007/BF02641886.
Fifty-six occluded iliac arteries (mean length 6.1 cm; range 1-17 cm) in 50 patients were treated by percutaneous transluminal angioplasty (PTA) or laser-assisted PTA (bilateral lesions in 6 patients). Twenty-seven patients (54%) were at high risk for surgery. Patients were followed for a maximum period of 72 months (mean 23.12 months; median 20 months). The initial success rate was 78.57% for arteries and 82% for patients. Laser-assisted PTA was attempted in 11 occluded arteries (19.64%) and was successful in 4 arteries (7.14%). Conventional PTA was successful in 71.4% of arteries including all 7 arteries for which laser-assisted PTA failed (76% of patients). PTA was unsuccessful in 12 arteries (21.43%). Urokinase was used before PTA in 1 artery. The effect of PTA was evident clinically by relief of rest pain (66.66%), healing of ulcer (57%), increased claudication distance or no claudication (79%) in limbs, and objectively, by improvement in ankle/arm index (AAI) (an increase of 0.16 to 0.91) and increased exercise tolerance. Continuous improvement in AAI was observed after PTA on follow-up in 9 limbs. One patient died during follow-up. On follow-up, 3 arteries were occluded, 6 showed evidence of stenosis, and 1 showed fusiform dilatation at the PTA site. The long-term results using the life-table method determined a 76% primary patency rate and 81% secondary patency rate for 72 months. The overall patency including failures was 63%. Age of the patients (p = 0.0169) and hypertension (p = 0.0015) significantly affected the long-term patency of the artery but not the initial success. The major complications were arterial rupture in a repeat procedure in 1 artery, axillary artery thrombosis in 1, and distal thromboembolic occlusion during PTA in 4. The long-term patency rates suggest that PTA of totally occluded iliac arteries is a safe and effective procedure and provides a long-term benefit.
对50例患者的56条闭塞性髂动脉（平均长度6.1 cm；范围1 - 17 cm）进行了经皮腔内血管成形术（PTA）或激光辅助PTA治疗（6例患者为双侧病变）。27例患者（54%）具有手术高风险。对患者进行了最长72个月的随访（平均23.12个月；中位数20个月）。动脉的初始成功率为78.57%，患者的初始成功率为82%。对11条闭塞动脉（19.64%）尝试了激光辅助PTA，其中4条动脉（7.14%）成功。传统PTA在71.4%的动脉中成功，包括激光辅助PTA失败的所有7条动脉（76%的患者）。12条动脉（21.43%）PTA未成功。1条动脉在PTA前使用了尿激酶。PTA的效果在临床上表现为静息痛缓解（66.66%）、溃疡愈合（57%）、肢体间歇性跛行距离增加或无间歇性跛行（79%），客观上表现为踝/臂指数（AAI）改善（增加0.16至0.91）和运动耐量增加。9条肢体在PTA后的随访中观察到AAI持续改善。1例患者在随访期间死亡。随访时，3条动脉闭塞，6条有狭窄证据，1条在PTA部位显示梭形扩张。使用寿命表法得出的长期结果显示，72个月时的初级通畅率为76%，次级通畅率为81%。包括失败病例在内的总体通畅率为63%。患者年龄（p = 0.0169）和高血压（p = 0.0015）显著影响动脉的长期通畅率，但不影响初始成功率。主要并发症包括1条动脉在重复手术中动脉破裂、1条腋动脉血栓形成以及4条在PTA期间远端血栓栓塞性闭塞。长期通畅率表明，完全闭塞性髂动脉的PTA是一种安全有效的手术方法，并能带来长期益处。
