平肾主动脉-髂动脉闭塞性病变腔内治疗  

Endovascular treatment of infrarenal aortoiliac occlusive diseases

作　　者：魏小龙[1] 吴雅妮[1] 孙羽东 朱江[1] 苏鹏桓 冯睿[1] 周建[1] 赵志青[1] 景在平[1] 

机构地区：[1]第二军医大学附属长海医院血管外科,上海200433

出　　处：《介入放射学杂志》2016年第5期387-390,共4页Journal of Interventional Radiology

基　　金：国家自然科学基金(81330034)

摘　　要：目的探讨腔内治疗平肾主动脉-髂动脉闭塞性病变的效果。方法回顾性分析2013年1月至2015年6月采用腔内微创治疗和血运重建的21例平肾主动脉-髂动脉闭塞性病变患者．所有患者均在置管溶栓后接受腔内血管重建，术后3、6、9、12个月随访，每年复查主动脉CTA。结果21例均置管溶栓24h，完全采用裸支架倒Y型腔内重建11例（植入主动脉裸支架和外周自膨裸支架41枚），覆膜支架对吻成形2例（植入Gore Viabahn支架4枚），Gore Excluder覆膜支架腔内重建8例，技术成功率为100％。围手术期无死亡患者及严重并发症发生，所有患者术后下肢缺血症状均得到缓解。术后随访6～24个月，未见支架移位及内漏发生，裸支架治疗组1例术后8个月髂动脉支架内血栓闭塞，予以药物保守治疗；Gore Excluder覆膜支架组1例术后18个月一侧髂支远端狭窄，予以裸支架成形后通畅；其余移植物随访期通畅。结论腔内微创治疗平肾主动脉-髂动脉闭塞近、中期效果好，但需个体化选择治疗方案，以提高手术成功率．降低并发症发生率。Objective To evaluate the therapeutic effect of endovascular treatment for infrarenal （below the level of the renal artery） aortoiliac occlusive diseases. Methods The clinical data of 21 patients with infrarenal aortoiliae occlusive disease, who were admitted to authors＇ hospital during the period from January 2013 to June 2015 to receive endovascular minimally-invasive treatment and reconstruction of blood circulation, were retrospectively analyzed. All patients underwent endovascular stenting angioplasty. Followup examination was conducted at 3, 6, 9 and 12 months after the treatment, and CT angiography was performed once a year. Results Catheter-directed thrombolysis lasting for 24 hours was carried out in all 21 patients. Bare metal stents of inverted Y type were used to make endovascular reconstruction in 11 patients, and a total of 41 aortic bare metal stents and peripheral self-expanding stents were implanted. Covered stents in kissing configuration were employed in 2 patients, and a total of 4 Gore Viabahn stents were used. Endovascular reconstruction with Gore Excluder covered stent implantation was performed in 8 patients, the technical success rate was 100%. No death or severe complications occurred in perioperative period, and the symptoms of lower limb ischemia were improved in all patients. The patients were followed up for 6-24 months, no stent displacement or endoleak was observed. One patient in bare stent treatment group developed iliae artery stent thrombosis in 8 months after the treatment, and conservative treatment with medication was adopted. One patient in Gore Excluder covered stent treatment group developed unilateral distal iliac artery stenosis in 18 months after the treatment, and the artery returned unobstructed after angioplasty with bare metal stent. All the other grafts remained patent in follow- up period. Conclusion For infrarenal aortoiliac occlusive diseases, endovascular minimally-invasive treatment has excellent short-term and mid-term effect, however, in order to impr

关 键 词：平肾主动脉-髂动脉闭塞 覆膜支架 腔内治疗 置管溶栓 

分 类 号：R654.4[医药卫生—外科学]