肱动脉和股动脉穿刺入路支架成形术治疗单侧髂动脉慢性闭塞的比较研究  

Stenting angioplasty via brachial artery access versus via femoral artery access in treating chronic occlusion of unilateral iliac artery: a comparative study

作　　者：周龙[1] 梁思渊[1] 王涛 叶开创[2] 陆信武[2] ZHOU Long;LIANG Siyuan;WANG Tao;YE Kaichuang;LU Xinwu(Department of Vascular Surgery,Taizhou Municipal Hospital,Taizhou,Zhejiang Province 318000,China)

机构地区：[1]台州市立医院血管外科,浙江318000 [2]上海交通大学医学院附属第九人民医院血管外科

出　　处：《介入放射学杂志》2021年第2期127-131,共5页Journal of Interventional Radiology

摘　　要：目的比较左侧肱动脉和健侧股动脉穿刺入路腔内支架成形术治疗单侧髂动脉慢性闭塞患者的安全性、可行性和有效性。方法回顾性分析2013年1月至2017年12月分别采用左侧肱动脉(A组)、健侧股动脉(B组)穿刺入路腔内支架成形术治疗的133例、116例单侧髂动脉慢性闭塞患者围手术期资料和随访结果。分别以围手术期并发症发生率、技术成功率和支架通畅率评估两种穿刺入路手术的安全性、可行性和有效性。结果A组、B组间性别、患肢、泛大西洋学会联盟(TASC)-Ⅱ分型、Rutherford分级等差异均无统计学意义(P>0.05)。A组总体并发症发生率为22.6%(30/133),显著高于B组(12.1%,14/116)(P=0.03),以穿刺点并发症最为明显,分别为17.3%(23/133)、6.9%(8/116)(P=0.02)。但A、B组间严重并发症(需要进一步干预、住院时间延长、输血、不可逆损伤、死亡等)发生率差异无统计学意义(12.0%对7.8%,P=0.30)。A组初始技术成功率高于B组(88.7%对76.7%,P=0.02),但联合患侧股动脉穿刺逆向开通时分别为97.0%、97.4%(P=1.00)。A、B组间术后2年髂动脉支架一期通畅率分别为87.7%、86.7%,二期通畅率分别为92.1%、96.3%,差异均无统计学意义(P>0.05)。结论健侧股动脉穿刺入路腔内支架成形术治疗单侧髂动脉慢性闭塞更安全,技术成功率虽较低于左侧肱动脉穿刺入路,但联合患侧股动脉穿刺可显著提高技术成功率。Objective To compare the safety, feasibility and effectiveness of endovascular stenting angioplasty via left brachial artery access with those via healthy femoral artery access in patients with chronic occlusion of unilateral iliac artery. Methods The clinical data and follow-up results of 249 patients with chronic occlusion of unilateral iliac artery, who received endovascular stenting angioplasty from January 2013 to December 2017, were retrospectively analyzed. According to the access route employed, the patients were divided into group A(via left brachial artery access, n=133) and group B(via healthy side femoral artery access,n=116). The perioperative complication rate, technical success rate and stent patency rate were adopted to evaluate the safety, feasibility and effectiveness of the two techniques. Results There were no significant differences in gender, side of diseased limb, TASC-Ⅱ classification and Rutherford classification between the two groups. The total incidence of complications in group A was 22.6%, which was remarkably higher than 12.1%in group B(P=0.03). The puncture-site complications were most commonly seen in both group A(17.3%) and group B(6.9%)(P =0.02). No statistically significant difference in the incidence of severe complications(requiring further intervention, prolonged hospitalization, blood transfusion, irreversible injury, death, etc.)existed between group A(12.0%) and group B(7.8%)(P=0.30). The initial technical success rate in group A was 88.7%, which was obviously higher than 76.7% in group B(P=0.02), but when femoral artery puncture of diseased side was together punctured to perform retrograde recanalization the technical success rate in group A and group B was 97.0% and 97.4% respectively(P=1.00). In group A and group B, the 2-year primary patency rates of iliac artery stent were 87.7% and 86.7% respectively, the secondly patency rates were 92.1%and 96.3% respectively, and the differences between the two groups were not statistically significant(P>0.05).Conclusion In trea

关 键 词：髂动脉闭塞 肱动脉入路 健侧股动脉入路 并发症 支架成形术 

分 类 号：R622.4[医药卫生—整形外科]