血管腔内移植物在TASC C及D型股腘动脉闭塞血管腔内治疗中应用的长期临床结果  

Long-term results of stent graft in the treatment of TASC C,D femoropopliteal artery occlusive disease

作　　者：叶猛[1] 倪其泓[1] 薛冠华[1] 郭相江[1] 王预立 张岚[1] Ye Meng;Ni Qihong;Xue Guanhua;Guo Xiangjiang;Wang Yuli;Zhang Lan(Department of Vascular Surgery,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200120,China)

机构地区：[1]上海交通大学医学院附属仁济医院血管外科,上海200120

出　　处：《中华普通外科杂志》2023年第2期113-117,共5页Chinese Journal of General Surgery

基　　金：上海交通大学医学院附属仁济医院临床科研创新培育基金(PYIII-20-13)。

摘　　要：目的评价支架移植物Viabahn在TASC C及D型股腘动脉粥样硬化性闭塞血管腔内治疗中的长期结果。方法对2013年9月至2020年3月在上海交通大学医学院附属仁济医院血管外科接受Viabahn治疗的慢性股腘动脉闭塞患者进行回顾性分析。评价腔内操作的围手术期并发症发生率,术后1、3、5年的靶血管一期通畅率、二期通畅率、免于临床症状驱动的靶病变血运重建率(freedom from clinically-driven target lesion revascularization,F-TLR)、大截肢率以及全因死亡率。结果65例患者(67条下肢)接受了股腘动脉Viabahn植入。其中TASC C型病变20条(29.9%),TASC D型47条(70.1%)。平均病变长度(29.1±9.4)cm。48条(71.6%)原发性病变患肢为慢性完全闭塞病变(chronic total occlusion,CTO),CTO病变平均长度(26.1±10.4)cm。技术成功率98.6%。植入Viabahn的平均长度(31.3±10.1)cm。5年大截肢率4.2%,全因死亡率23.1%,术后1、3、5年一期通畅率为76.8%、59.4%、50.9%,一期辅助通畅率为88.4%、83.4%、83.4%,二期通畅率为88.4%、85.8%、85.8%,术后1、3、5年免于靶病变干预率为88.2%、76.9%、73.1%。结论对于病变较长的TASC C及D型股腘动脉闭塞,Viabahn植入是一种安全有效的血管腔内治疗手段。Objective To evaluate the long-term outcome of Viabahn stent graft in the treatment of complex femoropopliteal occlusive lesions.Methods From Sep 2013 to Mar 2020,clinical data of TASC C and D femoropopliteal lesions treated with Viabahn were retrospectively analyzed.Patency rates,the freedom rate from clinically-driven target lesion revascularization(F-TLR),limb salvage and survival after five years were calculated.Results A total of 65 patients(67 lower limbs)were included.20 limbs were TASC C lesions,47 limbs were TASC D lesions.The mean lesion length was(29.1±9.4)cm,including 48 chronic total occlusion(CTO)lesions(71.6%)with mean lesion length of(26.1±10.4)cm.Technique success rate was 98.6%.Mean length of stent graft was(31.3±10.1)cm.Major amputation was performed in 4.2%cases within 5 years.All-cause mortality in 5 years was 23.1%.Primary patency rates at 1,3,and 5 years were 76.8%,59.4%,50.9%,Assisted primary patency rates were 88.4%,83.4%,83.4%and secondary patency rates were 88.4%,85.8%,and 85.8%.F-TLR at 1,3 and 5 year was 88.2%,76.9%,73.1%.Conclusion Viabahn for complex and long femoropopliteal artery occlusions is an acceptable treatment with fair long-term outcome.

关 键 词：周围动脉疾病 支架 股腘动脉 腔内治疗 

分 类 号：R654.4[医药卫生—外科学]