Treiman G S, Schneider P A, Lawrence P F, Pevec W C, Bush R L, Ichikawa L
Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City 84132, USA.
J Vasc Surg. 1998 Jul;28(1):104-12; discussion 113-4. doi: 10.1016/s0741-5214(98)70205-8.
This study was undertaken to determine the results and complications of stents placed for initially unsuccessful or complicated iliac percutaneous transluminal angioplasty (PTA), the effect of location (external iliac or common iliac) on outcome, and the influence of superficial femoral artery patency on benefit.
From 1992 through 1997, 350 patients underwent iliac artery PTA at the authors' institutions. Of this group, 88 patients (88 arteries) had one or more stents placed after PTA (140 stents in total) for residual stenosis or pressure gradient (63 patients), iliac dissection (12 patients), long-segment occlusion (10 patients), or recurrent stenosis (3 patients). Thirty patients required the placement of more than one stent. The indications for PTA in these 88 patients were claudication (48 patients) and limb-threatening ischemia (40 patients). Forty-seven patients had stents placed in the common iliac, 29 patients had stents placed in the external iliac, and 12 patients had stents placed in both. Seventy-one arteries (81%) were stenotic, and 17 (19%) were occluded before PTA. Sixty-six arteries were treated by interventional radiologists, 15 by a vascular surgeon, and 7 jointly.
Criteria for success included (1) increase of at least one clinical category of chronic limb ischemia from baseline or satisfactory wound healing, (2) maintenance of an ankle/brachial index increase of more than 0.10 above the preprocedure index, and (3) residual angiographic stenosis less than 25% and, for patients with pressure gradient measurements, a residual gradient less than 10 mm Hg.
Stent placement was accomplished in all 88 patients with 16 (18%) major complications. Mean follow-up was 17 months (range, 3 to 48 months). By life-table analysis, success was 75% at 1 year, 62% at 2 years, and 57% at 3 years. No cardiovascular risk factor or independent variable was statistically significant in predicting success. There was no difference in success rates for common iliac or external iliac lesions. Superficial femoral artery patency did not correlate with outcome.
Although stents can eliminate residual lesions and arterial dissection, these patients are likely to require adjuvant or subsequent procedures to attain clinical success. By controlling the PTA complication and treating the emergent problem, stents may allow for subsequent elective intervention.
本研究旨在确定对最初经皮腔内血管成形术（PTA）未成功或出现并发症的髂动脉植入支架的结果及并发症、部位（髂外动脉或髂总动脉）对结果的影响，以及股浅动脉通畅情况对获益的影响。
1992年至1997年期间，350例患者在作者所在机构接受了髂动脉PTA。在该组患者中，88例患者（88条动脉）在PTA后因残余狭窄或压力阶差（63例患者）、髂动脉夹层（12例患者）、长段闭塞（10例患者）或再狭窄（3例患者）植入了一个或多个支架（共140个支架）。30例患者需要植入多个支架。这88例患者进行PTA的指征为间歇性跛行（48例患者）和肢体威胁性缺血（40例患者）。47例患者在髂总动脉植入支架，29例患者在髂外动脉植入支架，12例患者在双侧植入支架。71条动脉（81%）在PTA前为狭窄性病变，17条（19%）为闭塞性病变。66条动脉由介入放射科医生治疗，15条由血管外科医生治疗，7条由双方联合治疗。
成功标准包括：（1）慢性肢体缺血的临床分级较基线至少提高一级或伤口愈合良好；（2）踝/臂指数较术前指数增加至少0.10并维持该水平；（3）血管造影显示残余狭窄小于25%，对于测量了压力阶差的患者，残余阶差小于10 mmHg。
所有88例患者均成功植入支架，其中16例（18%）出现严重并发症。平均随访时间为17个月（范围3至48个月）。通过寿命表分析，1年时成功率为75%，2年时为62%，3年时为57%。在预测成功方面，没有任何心血管危险因素或独立变量具有统计学意义。髂总动脉或髂外动脉病变的成功率没有差异。股浅动脉通畅情况与结果无关。
尽管支架可以消除残余病变和动脉夹层，但这些患者可能需要辅助或后续治疗才能取得临床成功。通过控制PTA并发症并处理紧急问题，支架可能允许后续进行择期干预。
