动脉粥样硬化所致髂-股动脉狭窄或闭塞的血管腔内介入治疗

摘要

Objective To investigate the feasibility and efficacy of iliofemoral endovascular therapy for the treatment of chronic ischemia of lower extremities due to arterial atherosclerosis. Methods During the period of September 2005-January 2009 percutaneous endovascular angioplasty and stent implantation were performed in 15 consecutive patients with CTA-proved chronic occlusive iliofemoral artery disease. The patients included 11 males and 4 females with a mean age of (72.1 ± 5.9) years (ranged from 61 to 82 years). Before the procedure, all patients underwent clinical and imaging assessments, including Fontaine classification, ankle-brachial pressure index (ABI), and lower limb computed tomography angiography (CTA). According to the length, morphology and location of the occlusive segment, different types of stents were employed together with pereutaneous transluminal angioplasty (PTA) to treat the occluded lilac or superficial femoral artery. At the end of the procedure, distal angiogram was performed to assess the success of the procedure and to exclude thromboembolism or dissection complications. After PTA, the residual stenosis < 30% and/or pressure gradient < 10 mmHg were defined as technical success. Clinical success was identified when patient's clinical symptoms were improved by one or more grade according to Fontaine classification. Results Technical success was totally achieved in all patients with no occurrence of complication. Recanalization of the occluded artery was performed preferably by retrograde ipsilateral femoral artery approach in 5 patients and by contralateral access using the crossover aorta technique in 10 patients. PTA was performed in all patients after stent release to open the occluded vessel to its normal diameter. The mean length of the lilac arterial segment covered with 8 stents was (7.6 ± 1.4) cm (ranged from 6 cm to 10 cm). The mean diameter ± SD of the iliac stents was 9.5 mm ± 1.4 mm (ranged from 8 mm to 12 mm). The mean length of 5 superficial artery implanted stents was (4.5 ± 1.1) cm (ranged from 4 cm to 6 cm). The mean ABI before treatment and six months after treatment was 0.64 (range 0.41 to 0.89) and 0.76 (range 0.50 to 0.95), respectively. The difference in ABI between pre-interventional and post-interventional procedure was statistically significant (t = -4.64, P < 0.01). Clinical improvements according to Fontaine classification were obtained in all patients, in whom technical success was achieved (100%). Conclusion Endovascular interventional procedure is a safe and effective treatment for iliofemoral arterial occlusive disease due to arterial atherosclerosis. PTA combined with subsequent stent implantation can well improve the patient's quality of life as well as the hemodynamics of lower extremities, which is very important for preserving the diseased limb for a long period of time.%目的 探讨动脉粥样硬化所致慢性下肢缺血通过髂-股动脉腔内介入治疗的可行性和疗效.方法 15例患者经多排螺旋CT下肢血管造影证实为动脉硬化性髂.股动脉狭窄或闭塞性病变行经皮腔内成形术(PTA)和支架植入术.通过术后血管造影及临床症状改善等来评价治疗效果.PTA术后病变段血管残余狭窄<30%被认为技术成功;按照Fontaine分型治疗后临床症状改善1级或1级以上被认为临床成功.结果 经同侧逆行PTA及支架植入术5例,共计6段同侧髂动脉血管.包括植入髂动脉支架3枚、3段髂动脉行VFA术;跨主动脉对侧髂.股动脉PTA及支架植入术10例,共计20支病变血管,包括植入髂动脉支架5枚、股浅动脉支架5枚、10支股动脉行PTA术.髂股动脉支架、成形术后重复血管造影证实所有病变段血管血流明显改善,技术成功率为100%,无血管夹层及血栓形成等并发症.临床随访2～24个月,平均11.9个月,术前及术后6个月踝臂指数测定差异具有统计学意义(t=-4.64,P<0.01).术后6个月Fontaine分型提高1、2和3级的患者分别有7、5和3例,所有患者均未施行截肢(趾)术,随访期间临床有效率为100%.结论 动脉粥样硬化性髂-股动脉狭窄或闭塞的腔内介入治疗是一种安全、有效的治疗方法,能够改善患者的生存质量,及早改善下肢外周动脉病患者的血运状况,为中长期保肢提供较好途径.