TASC-D型主髂动脉硬化闭塞症腔内治疗的疗效分析  

Efficacy of endovascular treatment of Trans-Atlantic Inter-Society Consensus D aortoiliac occlusive disease

作　　者：何昊[1] 李全明[1] 黎明[1] 李鑫[1] 舒畅[1] He Hao;Li Quanming;Li Ming;Li Xin;Shu Chang(Department of Vascular Surgery,The Second Xiangya Hospital,The Institute of Vascular Diseases,Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院血管外科、中南大学血管病研究所,长沙410011

出　　处：《中华血管外科杂志》2023年第1期26-31,共6页Chinese Journal of Vascular Surgery

基　　金：湖南省自然科学基金(2022JJ80038);长沙市“揭榜挂帅”重大科技项目(kq2102003)。

摘　　要：目的探讨TASC-D型主髂动脉硬化闭塞症(AIOD)腔内治疗的疗效及预后。方法回顾性分析2016年1月至2021年12月中南大学湘雅二医院血管外科115例行腔内治疗的TASC-D型AIOD患者的临床资料。术前根据Rutherford临床分级及相应的影像学检查拟定治疗方案。术后随访,观察临床症状、踝肱指数(ABI)、并发症发生率和通畅率情况。结果115例患者(148条靶血管)均实施了腔内治疗,总体技术成功率为98.3%(113/115),靶血管开通率为98.6%(146/148)。术后Rutherford分级较术前提高4级4例,3级58例,2级24例,1级1例,无改善28例。术后1周ABI较术前提高,差异有统计学意义[0.9(0.8,1.1)比0.2(0,0.4),Z=-14.233,P<0.001]。30 d手术相关并发症发生率为4.3%(5/115)。113例患者(144条靶血管)获得随访,中位随访时间为37(21,57)个月。术后1、3和5年累积生存率分别为97.2%、95.6%和89.7%。术后1、3和5年累积主髂动脉免于再次手术干预率分别为90.4%、86.1%和83.5%。术后1、3和5年累积一期通畅率分别为90.4%、85.2%和82.5%,1和3年累积二期通畅率分别为92.9%和85.1%。结论腔内技术治疗TASC-D型AIOD是一种安全、有效的治疗方法,中远期临床效果令人满意。Objective To investigate the clinical efficacy and prognosis of endovascular treatment of Trans-Atlantic Inter-Society Consensus D(TASC-D)aortoiliac occlusive disease(AIOD).Methods A retrospective analysis was made of the clinical data of 115 patients with TASC-D AIOD in the Department of Vascular Surgery of the Second Xiangya Hospital of the Central University from January 2016 to December 2021.Before the operation,a therapeutic protocol was instituted according to Rutherford classification and corresponding imaging examination.All patients underwent endovascular interventions and were followed up regularly.Their clinical symptoms,ankle-brachial index(ABI),complication rate,and patency rate were observed annually.Results All 115 patients with 148 target vessels underwent endovascular treatment.The overall success rate of endovascular therapy was 98.3%(113/115),and the patency rate of target vessels was 98.6%(146/148).Postoperative Rutherford classification was improved by 4 grades in 4 patients,3 grades in 58 patients,2 grades in 24 patients,1 grade in 1 patient,and no improvement in 28 patients.ABI at one week after the operation was significantly higher than that before the operation[0.9(0.8,1.1)vs 0.2(0,0.4),Z=-14.233,P<0.001].Postoperative complications occurred in 5(4.3%)patients in 30 days.Moreover,113 patients(144 target vessels)were followed up with a median follow-up time of 37(21,57)months.The 1-,3-and 5-year cumulative survival rates were 97.2%,95.6%and 89.7%,respectively.The 1,3 and 5 years cumulative freedom from reintervention rates were 90.4%,86.1%and 83.5%,respectively.The cumulative primary patency rates were 90.4%,85.2%and 82.5%at 1,3 and 5 years,respectively.The cumulative secondary patency rates were 92.9%and 85.1%at 1 and 3 years,respectively.Conclusion Endovascular therapy is safe and effective for TASC-D AIOD with satisfactory mid-and long-term clinical results.

关 键 词：主髂动脉闭塞性疾病 腔内血管成形术 血管支架 

分 类 号：R654.3[医药卫生—外科学]