Tyagi S, Verma P K, Gambhir D S, Kaul U A, Saha R, Arora R
Department of Cardiology, G.B. Pant Hospital, Maulana Azad Medical College, New Delhi, India.
Cardiovasc Intervent Radiol. 1998 May-Jun;21(3):219-24. doi: 10.1007/s002709900248.
To compare the early and long-term outcomes of subclavian artery angioplasty in patients with aortoarteritis and atherosclerosis.
Sixty-one subclavian artery angioplasties were performed in 55 consecutive patients with aortoarteritis (n = 32) and atherosclerosis (n = 23) between 1986 and 1995. An arch aortogram followed by a selective subclavian artery angiogram was done to profile the site and extent of the lesion, its relation to the vertebral artery, and the distal circulation. Percutaneous transluminal angioplasty (PTA) was performed via the femoral route for 56 stenotic lesions and 5 total occlusions.
PTA was successful in 52 (92.8%) stenotic lesions and 3 (60%) total occlusions. Three patients (5.4%) had complications, that could be effectively managed nonsurgically. Compared with atherosclerosis, patients with aortoarteritis were younger (27.4 +/- 9.3 years vs 54.5 +/- 10.5 years; p < 0.001), more often female (75% vs 17.4%; p < 0.001), gangrene was uncommon (0% vs 17.4%; p < 0.05), and diffuse involvement was seen more often (43.8% vs 4.4%; p < 0.001). The luminal diameter stenoses were similar before PTA (88.6 +/- 9.7% vs 89.0 +/- 9.1%; p = NS). Higher balloon inflation pressure was required to dilate the lesions of aortoarteritis (9.9 +/- 4.6 ATM vs 5.5 +/- 1.0 ATM; p < 0.001). This group had more residual stenosis (15.5 +/- 12.4% vs 8.3 +/- 9.4%; p < 0.05) after PTA. There were no neurological sequelae, even in PTA of prevertebral lesions. On 3-120 months (mean 43.3 +/- 28.9 months) follow-up of 40 patients, restenosis was more often observed in patients with aortoarteritis, particularly in those with diffuse arterial narrowing. These lesions could be effectively redilated. Clinical symptoms showed marked improvement after successful angioplasty.
Subclavian PTA is safe and can be performed as effectively in aortoarteritis as in atherosclerosis, with good long-term results. Long-term follow-up shows that it provides good symptomatic relief.
比较大动脉炎和动脉粥样硬化患者锁骨下动脉血管成形术的早期和长期疗效。
1986年至1995年间，对55例连续的大动脉炎患者（n = 32）和动脉粥样硬化患者（n = 23）进行了61次锁骨下动脉血管成形术。先进行主动脉弓血管造影，然后进行选择性锁骨下动脉血管造影，以明确病变的部位和范围、其与椎动脉的关系以及远端循环情况。对56处狭窄病变和5处完全闭塞病变经股动脉途径进行经皮腔内血管成形术（PTA）。
PTA对52处（92.8%）狭窄病变和3处（60%）完全闭塞病变治疗成功。3例患者（5.4%）出现并发症，可通过非手术方法有效处理。与动脉粥样硬化患者相比，大动脉炎患者更年轻（27.4±9.3岁对54.5±10.5岁；p<0.001），女性更多见（75%对17.4%；p<0.001），坏疽少见（0%对17.
