C/D级主髂动脉病变腔内治疗的中远期结果  

The mid-term and long-term results of endovascular treatment of C/D aorto-iliac artery occlusive disease

作　　者：贾鑫[1] 郭伟[1] 刘小平[1] 熊江[1] 马晓辉[1] 张宏鹏[1] 许永乐[1] Jia Xin;Guo Wei;Liu Xiaoping;Xiong Jiang;Ma Xiaohui;Zhang Hongpeng;Xu Yongle(Department of Vascular and Endovascular Surgery,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院血管外科,北京100853

出　　处：《中华医学杂志》2020年第29期2273-2277,共5页National Medical Journal of China

摘　　要：目的评估主髂动脉泛大西洋多学科专家共识(TASC)分类中C/D级病变腔内支架治疗的中远期临床结果。方法回顾性分析解放军总医院血管外科2008年1月至2018年1月主髂动脉TASC C/D级病变腔内支架治疗的临床数据。本研究共纳入172例患者,按照术中应用支架类型分为覆膜支架组(61例)、裸支架组(88例)和复合支架组(23例)。主要观察指标为靶血管一期通畅率;次要观察指标为免于再次手术干预、卢瑟福分级、截肢事件和全因死亡。结果覆膜支架组、裸支架组和复合支架组患者围手术期总体死亡率和各种并发症发生率差异均无统计学意义(均P>0.05)。Kaplan-Meier分析靶血管5年一期通畅率在覆膜支架组、裸支架组和复合支架组分别为82.1%、78.3%和71.9%,免于再次手术干预率分别为88.5%、82.6%和78.1%,差异均无统计学意义(χ2=3.47、2.93,均P>0.05);10年随访一期通畅率分别为68.7%、52.6%和58.1%,差异有统计学意义(χ2=18.91,P<0.05);免于再次手术干预率分别为74.1%、70.6%和65.9%,差异无统计学意义(χ2=6.16,P>0.05)。logistic逐步回归分析显示吸烟、糖尿病、TASC分类D级病变和应用裸支架是影响中远期通畅率的独立危险因素。结论主髂动脉TASC C/D级病变腔内支架治疗可以取得比较理想的中远期疗效,应用覆膜支架可能提高远期通畅率。Objective To evaluate the safety and efficacy of the endovascular treatment for Trans-Atlantic Society Consensus (TASC) C/D aorto-iliac artery occlusive disease in mid-term and long-term follow-up.Methods A total of 172 patients diagnosed with TASC C/D aorto-iliac lesions who received endovascular treatment from Chinese PLA General Hospital from January 2008 to January 2018 were retrospectively analyzed. The cohort was separated into covered stent group (61 cases), bare stent group (88 cases) and composite stent group (23 cases). Primary endpoint was primary patency, and secondary endpoints were freedom from target lesion revascularization (TLR) rate, major amputation rate and all cause death rate.Results There were no significant difference of peri-operational all cause death rate and complication rate among all the groups(all P>0.05). Kaplan-Meier was used to analyze the primary patency at 5 year, which were 82.1%, 78.3% and 71.9% in covered stent group, bare stent group and composite stent group (χ2=3.47, P>0.05) , and primary patency at 10 year were 68.7%, 52.6% and 58.1%, respectively (χ2=18.91, P<0.05) . Freedom from TLR at 5 year were 88.5%, 82.6% and 78.1% in covered stent group, bare stent group and composite stent group (χ2=2.93, P>0.05) , and freedom from TLR at 10 year were 74.1%, 70.6% and 65.9%, respectively (χ2=6.16, P>0.05) . Diabetes, smoking, TASC D lesions and bare stent were identified as predictors of restenosis by logistic regression analysis.Conclusions These results suggest that endovacular treatment is safe and effective to complex TASC C/D aorto-iliac artery occlusive disease in mid-term and long-term follow-up. The application of covered stent might further improve the long-term patency.

关 键 词：外周血管疾病 支架 治疗结果 

分 类 号：R654.3[医药卫生—外科学]