双向内膜下技术在锁骨下动脉闭塞血管内治疗中的应用  

The application of bidirectional subintimal technique in endovascular treatment of subclavian arterial occlusion

作　　者：叶猛[1] 倪其鸿 陈佳荃 郭湘江 张岚[1] 

机构地区：[1]上海交通大学医学院附属仁济医院血管外科,200126

出　　处：《介入放射学杂志》2018年第1期13-16,共4页Journal of Interventional Radiology

摘　　要：目的探讨锁骨下动脉闭塞血管内治疗中导丝无法回入真腔时应用双向内膜下技术——顺逆行内膜下动脉成形术(SAFARI)提高治疗成功率的可行性及安全性。方法回顾性分析2013年8月至2016年6月收治的11例症状性锁骨下动脉闭塞患者临床资料,其中男8例,女3例,平均年龄67(61~74)岁,均于开通闭塞血管失败后通过SAFARI技术重建锁骨下动脉。结果 10例患者通过SAFARI技术实现了锁骨下动脉再通并一期植入支架(平均长度46.4 mm),1例失败,技术成功率为90.9%。术后未发生严重并发症。电话随访6~36个月,未发现支架内再狭窄。结论 SAFARI技术治疗钙化严重、阻塞较长的锁骨下动脉闭塞安全有效,可进一步提高血管内治疗成功率。Objective To evaluate the feasibility and safety of using bidirectional subintimal technique, i.e. subintimal arterial flossing with antegrade-retrograde intervention （SAFARI）, in endovascular treatment of subclavian arterial occlusion when the guide wire cannot re- enter into the distal true cavity. Methods The clinical data of 11 patients with symptomatic subclavian artery occlusion, who were admitted to authors＇ hospital during the period from August 2013 to June 2016 to receive treatment, were retrospectively analyzed. The patients included 8 males and 3 females, with a mean age of 67 years old （61- 74 years）. Endovascular recanalization of subclavian artery with SAFARI technique and stent implantation were carried out in all patients after conventional reopening surgery of obstructed artery failed. Results Subclavian artery recanalization by using SAFARI technique together with implantation of stent （average length of 46.4 mm） was successfully accomplished in 10 patients, but in one patient the technical management failed, the technical success rate was 90.9%. No serious postoperative complications occurred. The patients were followed up for 6-36 months by telephone, and no in-stent restenosis was verified during the follow-up period. Conclusion In treating severely calcified and long-segmental subclavian artery occlusion, endovascular treatment using SAFARI technique is safe and effective, SAFARI technique can further improve the success rate of endovascular treatment. （J Intervent Radiol, 2018, 27： 13-16）

关 键 词：锁骨下动脉闭塞 血管内成形术 内膜下技术 

分 类 号：R543.5[医药卫生—心血管疾病]