Murphy T P, Webb M S, Lambiase R E, Haas R A, Dorfman G S, Carney W I, Morin C J
Division of Vascular and Interventional Radiology, Rhode Island Hospital, Brown University School of Medicine, Providence 02903.
J Vasc Interv Radiol. 1996 Jan-Feb;7(1):21-7. doi: 10.1016/s1051-0443(96)70727-3.
To assess the outcome of percutaneous placement of Wallstents for treatment of hemodynamically significant diffuse stenoses (> 3 cm in length), chronic occlusions, failed angioplasty procedures, and flow-limiting dissection in the iliac arteries.
Lesions in 94 iliac limbs were treated in 66 patients. Indications for stent placement included claudication in 49 limbs and limb-threatening ischemia in 45. Forty-two limbs were treated for diffuse disease, 39 for chronic occlusion, nine for failed angioplasty, and four for flow-limiting dissection.
Technical success was achieved in 86 of 94 limbs (91%), with major complications in 9% of patients. One death occurred within 30 days (not procedure-related). Ankle-brachial indexes improved from 0.51 +/- 0.24 to 0.76 +/- 0.22 (P < .001). Eighty-five percent demonstrated improvement under Rutherford criteria. Follow-up was obtained up to 38 months (mean, 14 months +/- 8). Cumulative primary patency rates were 78% at 1 year and 53% at 2 and 3 years (standard error 10%). Secondary patency rates were 86% at 1 year and 82% up to 32 months (standard error > 10% after 32 months). No significant decrease in mean ankle-brachial index was observed during follow up. No difference in primary patency was observed based on lesion type, symptom severity, lesion location, or runoff status. The limb salvage rate for patients with limb-threatening ischemia was 98% at a mean follow-up of 14 months +/- 7.
Technical success and complication rates for percutaneous iliac artery revascularization with use of Wallstents are favorable, symptoms improved in the majority of patients, and excellent secondary patency can be achieved. With use of Wallstents, most patients with iliac artery insufficiency as a result of long-segment disease or chronic occlusions can be treated percutaneously.
评估经皮置入Wallstent支架治疗血流动力学意义重大的弥漫性狭窄（长度>3 cm）、慢性闭塞、血管成形术失败以及髂动脉限流性夹层的效果。
对66例患者的94条髂动脉肢体病变进行了治疗。支架置入的适应证包括49条肢体的间歇性跛行和45条肢体的肢体威胁性缺血。42条肢体因弥漫性病变接受治疗，39条因慢性闭塞，9条因血管成形术失败，4条因限流性夹层。
94条肢体中的86条（91%）获得技术成功，9%的患者出现主要并发症。30天内发生1例死亡（与手术无关）。踝肱指数从0.51±0.24提高到0.76±0.22（P<.001）。85%的患者根据卢瑟福标准显示病情改善。随访时间长达38个月（平均14个月±8个月）。1年时的累积原发性通畅率为78%，2年和3年时为53%（标准误10%）。继发性通畅率1年时为86%，32个月时为82%（32个月后标准误>10%）。随访期间未观察到平均踝肱指数有显著下降。根据病变类型、症状严重程度、病变位置或流出道状态，原发性通畅率无差异。肢体威胁性缺血患者在平均随访14个月±7个月时的肢体挽救率为98%。
使用Wallstent支架进行经皮髂动脉血管重建的技术成功率和并发症发生率良好，大多数患者症状改善，可实现出色的继发性通畅。使用Wallstent支架，大多数因长节段疾病或慢性闭塞导致髂动脉供血不足的患者可经皮治疗。
