经皮腔内治疗髂闭塞105例的长期随访。

M. Henry, M. Amor, Geérard Ethevenot, I. Henry, B. Mentre, K. Tzvetanov
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引用次数: 72

摘要

目的评价经皮髂动脉闭塞再通术的远期疗效。方法经皮再通105例(男性97例;平均年龄56岁,范围34 ~ 80岁),髂闭塞采用溶栓(n = 15)、准分子激光(n = 4)、机械取栓(n = 16)、单纯球囊血管成形术(n = 23)和血管成形术加支架植入术(n = 69)。大多数病变(n = 72)位于髂总动脉(CIA);髂外动脉(EIA) 33例。结果一次再通率为88%(92/105),与部位(EIA: 90%, CIA: 86%)和病变长度无关,但与血栓年龄有关(< 3个月:100%,> 3个月:79%,p < 0.02)。并发症包括5例(4.8%)远端栓塞,采用血栓穿刺或福格蒂球囊栓塞切除术。7例(6.7%)早期血栓患者接受手术治疗。使用生命表分析计算所有105例患者6年时的原发性和继发性通畅率以及92例再通病灶。总体而言,原发性通畅率为52% (CIA: 58%, EIA: 34%),继发性通畅率为66% (CIA: 74%, EIA: 40%)。< 6 cm的原发性通畅率为70%,> 6 cm的原发性通畅率为31% (p < 0.01)。继发通畅率分别为86%和42% (p < 0.01)。再通病变中,原发性通畅61% (CIA: 69%, EIA: 38%),继发性通畅77% (CIA: 88%, EIA: 45%;P < 0.05)。< 6 cm的病变原发通畅率为72%,而较长的病变原发通畅率为44% (p < 0.04);二次通畅率分别为89%和59% (NS)。无支架的原发性通畅率为57%,有支架的为65% (NS);无支架和支架的二次通畅分别为71%和82% (NS)。结论经皮髂闭塞再通术是血管手术的真正替代方案和一线治疗选择。支架有改善长期结果的趋势,建议在慢性髂闭塞中常规使用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Percutaneous endoluminal treatment of iliac occlusions: long-term follow-up in 105 patients.
PURPOSE To evaluate the long-term results of percutaneous recanalization techniques in occluded iliac arteries. METHODS Percutaneous recanalization was attempted in 105 patients (97 men; mean age 56 years, range 34 to 80) with iliac occlusions using thrombolysis (n = 15), excimer laser (n = 4), mechanical thrombectomy (n = 16), balloon angioplasty alone (n = 23), and angioplasty plus stenting (n = 69). The majority of lesions (n = 72) were in the common iliac artery (CIA); 33 were in the external iliac artery (EIA). RESULTS The primary recanalization rate was 88% (92/105) independent of location (EIA: 90%, CIA: 86%) and lesion length, but dependent on age of thrombus (< 3 months: 100%, > 3 months: 79%, p < 0.02). Complications included 5 (4.8%) cases of distal embolism treated by thromboaspiration or Fogarty balloon embolectomy. Seven (6.7%) early thromboses were treated surgically. Primary and secondary patency rates were calculated at 6 years for all 105 cases and for the 92 recanalized lesions using life-table analysis. Overall, primary patency was 52% (CIA: 58%, EIA: 34%) and secondary 66% (CIA: 74%, EIA: 40%). Lesions < 6 cm had a primary patency of 70%, while those > 6 cm had a 31% rate (p < 0.01). Secondary patencies were 86% and 42%, respectively (p < 0.01). Among recanalized lesions, the primary patency was 61% (CIA: 69%, EIA: 38%) and secondary 77% (CIA: 88%, EIA: 45%; p < 0.05). Lesions < 6 cm had a primary patency rate of 72%, while longer lesions had a primary rate of 44% (p < 0.04); secondary patencies were 89% and 59%, respectively (NS). Primary patency without stent was 57% and with stent 65% (NS); secondary patency without stent was 71% and with stent 82% (NS). CONCLUSIONS Percutaneous recanalization of iliac occlusions represents a true alternative to vascular surgery and a first-line treatment option. Stents have a tendency to improve long-term results and are recommended for routine use in chronic iliac occlusions.
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