主髂动脉闭塞症腔内治疗新进展

主髂动脉闭塞症指以动脉粥样硬化为主要原因的腹主动脉远端、主髂动脉分叉部血管狭窄或闭塞, 导致盆腔、下肢缺血的一类疾病。外科开放手术一直是复杂主髂动脉病变的主要治疗手段。近年来, 随着血管腔内技术的发展, 其治疗理念有了极大改变。越来越多的证据表明, 腔内治疗的中远期效果已不劣于传统的开放手术, 成为主髂动脉闭塞症的首选治疗方案。     

TASC-Ⅱ C/DC/D级髂动脉闭塞的腔内治疗

目的探讨对泛大西洋协作组织(TASC)-ⅡC/D级髂动脉闭塞患者采用腔内治疗的疗效。方法回顾性分析我院血管外科2012年3月至2014年3月期间收治的25例TASC-ⅡC/D级髂动脉闭塞(共28条髂动脉,其中TASC-ⅡC级病变19条,TASC-ⅡD级病变9条)患者行腔内治疗的临床资料。结果 2条髂动脉闭塞未能开通,开通率为92.86%;其余26条髂动脉均行球囊扩张、支架置入术。踝肱指数由术前的0.23±0.18增至术后的0.76±0.19(P0.05)。2例穿刺处血肿,经保守治疗好转;1例出现支架内血栓,经置管溶栓后通畅。20例患者24条髂动脉获得随访,随访率为85.71%。随访时间3~24个月,平均8个月,其6个月、1年、2年累积一期通畅率分别为85%、80%、73%。结论 TASC-ⅡC/D级髂动脉闭塞腔内治疗的近期疗效好,创伤小,并发症少。     

TASCC、D级髂动脉病变的腔内治疗

目的探讨腔内技术治疗TASCC、D级髂动脉病变的可行性及近期疗效。方法回顾性总结77例TASCC、D级(共89条髂动脉)行腔内治疗患者的临床资料;其中TASCC级病变63例,TASCD级病变14例。结果 3条髂动脉未能开通闭塞段,开通率为96.6%。23条髂动脉行单纯经皮血管腔内成形术治疗,其余63条髂动脉置入支架。共置入支架104枚。踝肱指数由术前0.20±0.14增至术后7天的0.71±0.21(P=0.02)。主要并发症发生率3.9%。64例(78条髂动脉)患者获得随访,随访率83.1%;平均随访时间23(6～53)个月,其1、2、4年肢体通畅率分别为88%、84%和70%。结论腔内治疗TASCC、D级髂动脉病变安全微创,其短期效果较好。     

TAGC C、D级髂动脉病变的腔内治疗

目的 探讨腔内技术治疗TASC C、D级髂动脉病变的可行性及近期疗效.方法 回顾性总结77例TASCC、D级(共89条髂动脉)行腔内治疗患者的临床资料;其中TASC C级病变63例,TASC D级病变14例.结果 3条髂动脉未能开通闭塞段,开通率为96.6%.23条髂动脉行单纯经皮血管腔内成形术治疗,其余63条髂动脉置人支架.共置入支架104枚.踝肱指数由术前0.20±0.14增至术后7天的0.71±0.21(P=0.02).主要并发症发生率3.9%.64例(78条髂动脉)患者获得随访,随访率83.1%;平均随访时间23(6-53)个月,其1、2、4年肢体通畅率分别为88%、84%和70%.结论 腔内治疗TASC C、D级髂动脉病变安全微创,其短期效果较好.     

主髂动脉硬化闭塞症的腔内治疗

目的:探讨应用腔内技术治疗主髂动脉闭塞症的疗效。方法:对2005年1月—2011年5月34例主髂动脉闭塞的患者行腔内技术治疗,其中男28例,女6例;年龄42～79(平均58.3)岁。左侧髂动脉病变15例,右侧髂动脉病变12例,双侧髂动脉病变7例,包括累及腹主动脉末端2例。合并高血压30例,冠心病13例,糖尿病7例,脑血管病2例。术前均行CTA明确诊断。结果:34例主髂动脉闭塞的患者共植入支架44枚,临床症状改善。术后34例获得随访,随访时间1～36个月,1例再狭窄,狭窄程度50%,缺血症状不明显,未治疗。结论:应用腔内技术治疗主髂动脉闭塞症是一种有效的微创方法。     

TASC C 型及D 型主髂动脉闭塞的腔内治疗及评价

目的 探讨广泛主髂动脉闭塞的腔内治疗方法并评价其疗效.方法 32 例慢性广泛主髂动脉闭塞患者,男性23 例,女性9 例,年龄52耀81(平均69.7)岁.有明显的静息痛27 例(84.4%),足部坏疽5 例(15.62%).其中TASC C 型患者13 例(40.6%),TASC D 型患者19 例(59.4%),患者术前评估均为高龄、高危病例或不能耐受传统开腹手术的患者.经股动脉或肱动脉入路,采用闭塞段通过、球囊扩张、支架放置及股总动脉内膜剥脱等方法进行治疗.结果 除3 例未能开通外,其余29 例均获开通,开通率为90.63%,并发症发生率为3.5%.21 例患者临床症状中度改善,8 例患者临床症状明显改善.平均随访(13.9依1.2)个月,术后6 个月的初次通畅率、辅助初次通畅率及二次通畅率分别为82.8%、86.2%、89.7%,术后12 个月的初次通畅率、辅助初次通畅率及二次通畅率分别为67%、74.5%、81.9%.结论 对于合并广泛慢性主髂动脉闭塞的高危患者,综合应用多种方法进行腔内治疗是一项安全有效的措施,可获得较满意的临床疗效.     

腔内治疗TASCⅡD型髂动脉硬化闭塞症并发症12例分析

目的 探讨腔内技术治疗泛大西洋协作组织(TransAtlantic Inter-Society Consensus,TASC)诊治指南ⅡD型髂动脉硬化闭塞症并发症的原因及防治策略.方法 2014年6月～2019年12月,我院采用腔内技术治疗TASCⅡD型髂动脉硬化闭塞症57例,发生围手术期并发症12例,对其资料进行回顾...     

腔内治疗主髂动脉粥样硬化闭塞症的疗效分析

目的 探讨腔内治疗对主髂动脉粥样硬化闭塞症的临床疗效.方法 收集2016年1月至2020年12月中国医学科学院阜外医院收治的153例主髂动脉闭塞症患者的临床资料,所有患者均行主髂动脉腔内介入治疗,统计其临床疗效.结果 153例主髂动脉闭塞症患者中,共183条肢体行腔内治疗,其中1例患者行单纯球囊扩张术,15例患者行导管...     

左侧髂内动脉臀下动脉移位治疗右侧髂总动脉硬化性闭塞症一例

1995年10月，本院用左侧髂内动脉和臀下动脉移位．与右侧髂外动脉行端侧吻合，治疗右侧髂总动脉硬化性闭塞症1例，术后8年效果良好，报告如下。     

支架成形术治疗髂动脉慢性闭塞症的中长期疗效分析

目的:评价支架成形术治疗髂动脉慢性闭塞症的中长期疗效。方法 :回顾性分析我科自2004年1月至2009年12月经支架成形术治疗的髂动脉慢性闭塞病人的技术成功率、支架通畅率及介入并发症。结果:髂动脉慢性闭塞症病人167例(194条患肢)纳入研究,男103例(126条患肢),女64例(68条患肢);平均年龄(71.3±12.4)岁。TASC B型47例(54条患肢),TASC C型88例(102条患肢),TASC D型32例(38条患肢)。TASC B型、C型、D型技术成功率分别为98.1%(53/54)、97.1%(99/102)、94.7%(36/38),各组比较无统计学差异;髂动脉支架成形术后1年一期通畅率、一期辅助通畅率和二期通畅率分别为94.6%、98.8%和98.8%,2年分别为90.0%、94.5%和96.2%,5年分别为78.8%、89.4%和93.5%,TASC各型之间无统计学差异。肱动脉穿刺部位血肿多于股动脉(P=0.047)。结论:支架成形术治疗髂动脉慢性闭塞安全、有效,技术成功率、支架通畅率和并发症发生率与TASCⅡ分型无相关性。     

Endovascular treatment for long segment iliac artery occlusion involving the iliac artery opening

ObjectiveThis retrospective nonrandomized study investigated the outcomes of endovascular therapy for long-segment iliac artery occlusion involving the iliac artery opening.MethodsDuring a 5-year period (from Mar 2012 to Mar 2017), 32 patients (two women and 30 men; mean age, 69.0 years; range, 51–90 years) received endovascular therapy, with or without catheter-directed thrombolysis (CDT), for long-segment iliac artery occlusion (mean lesion length, 129.8 mm; range, 74.7–189.3 mm).ResultsThe technical success rate was 90.6% (29 of 32). The major complication rate was 3.5%, but no in-hospital mortality was recorded. The access site complication rate was 10.3%. The clinical symptoms of 29 patients were significantly improved. All 29 patients were followed up for 6–40 months, with an average of 16.7 ± 10.9 months. The primary patency rates were 96.6 ± 3.4% at 6 months, 86.6 ± 7.3% at 12 months, 79.4 ± 9.6% at 24 months, and 66.2 ± 14.5% at 36 months.ConclusionsDepending on the characteristics of the disease, endovascular treatment with an individualized, rational choice of approach and with fine-tuning of the operation is a safe and effective treatment for long-term iliac artery occlusion involving the opening of the iliac arteries. Customization of the treatment is also the key to a successful operation and to ensuring good postoperative efficacy.     

The impact of female sex on the outcomes of endovascular treatment for iliac lesions

ObjectiveThe aim of this study was to evaluate early and long-term outcomes of stenting for iliac obstructive disease in women, comparing their results with those of men.MethodsA single-center retrospective analysis of iliac stenting procedures performed from 2010 to 2017 was conducted. Perioperative clinical, anatomic, and operative data, including mean artery diameters and stent diameters, were collected in a dedicated database. Early outcomes and long-term patency rates were compared between men and women; Cox proportional hazards modeling was used to identify independent predictors of patency.ResultsThere were 210 patients (298 limbs; women, n = 80 limbs [33%]; men, n = 218 limbs [66%]) treated. In comparing women with men, there were no differences in comorbidities (Society for Vascular Surgery score: women, 0.81 ± 0.54; men, 0.84 ± 0.60; P = .69) and TransAtlantic Inter-Society Consensus (TASC) classification (P = .49). At presentation, women had more advanced symptoms (Rutherford categories 5 and 6: women, 36.2%; men, 23.8%; P = .039) and smaller diameter at the level of the aortic bifurcation (women, 14.5 ± 3.6 mm; men, 16.0 ± 3.3 mm; P = .017), common iliac artery (women, 9.3 ± 1.5 mm; men, 10.0 ± 1.6 mm; P < .001), external iliac artery (EIA; women, 8.7 ± 1.5 mm; men, 10.1 ± 2.6 mm; P = .006), and common femoral artery (women, 7.3 ± 2.0 mm; men, 8.5 ± 2.1 mm; P = .034); similarly, the mean stent diameter was smaller (women, 8.9 ± 1.7 mm; men, 10.1 ± 4.4 mm; P = .03). The 30-day medical (P = .22) and surgical (P = .50) complication rates were similar. At 72 months, women had lower primary patency (women, 71%; men, 88%; P = .020) and secondary patency (women, 83%; men, 97%; P < .001) rates compared with men, whereas limb salvage rate was similar (women, 96%; men, 99%; P = .501). Multivariable analysis showed that female sex (hazard ratio [HR], 2.49; P = .04), ischemic tissue loss (HR, 2.48; P = .04), and stent diameter ≤7 mm (HR, 2.86; P = .01) were overall negative predictors of patency. Within women, EIA involvement (HR, 2.01; P = .04) and stent diameter ≤7 mm (HR, 3.79; P = .12) were also negative predictors.ConclusionsIliac stenting shows similarly good early outcomes in women and men. However, in the long term, primary and secondary patency rates are significantly lower in women, and this may be explained by smaller arterial diameter. In particular, a stent diameter ≤7 mm and EIA stenting were negative predictors of patency.     

Different endovascular modalities of treatment for isolated atherosclerotic popliteal artery lesions (EMO-POP) registry

BackgroundThe mid-term results after treatment of isolated popliteal lesions have been limited. The aim of the present study was to report the mid-term outcomes after endovascular treatment of isolated atherosclerotic popliteal artery lesions.MethodsA multicenter (15 hospitals in five countries) retrospective cohort study was performed. Between June 2016 and June 2021, 651 consecutive patients who had been treated for isolated popliteal lesions using endovascular methods exclusively were included in the present study. Six techniques were identified, including plain balloon angioplasty (PTA; n = 286; 43.9%), drug-coated balloon angioplasty (n = 98; 15.1%), stenting with low-chronic outward force (COF) stents (n = 84; 12.9%), stenting with high-COF stents (n = 76; 11.7%), atherectomy alone (n = 17; 2.6%), and directional atherectomy with drug-coated balloons (n = 90; 13.8%). The primary outcomes measures were primary and secondary patency and freedom from clinically driven target lesion revascularization (F-CDTLR).ResultsThe mean patient age was 74.5 years. Most of the patients (n = 409; 62.9%) had had chronic limb-threatening ischemia. Popliteal occlusion was found in 400 cases (61.4%). High-grade calcification was present in 36.7% of cases. Immediate technical success was 94.8%. The median follow-up was 26 months (range, 6-42 months). The actuarial rate for all patients at 26 months (per outcome measure) was as follows: primary patency, 73.9%; secondary patency, 88%; and F-CDTLR, 76.5%. When comparing PTA vs all other treatments in an adjusted regression analysis, the F-CDTLR was 75.2% for PTA vs 76.5% for all other treatment (hazard ratio, 1.06; 95% confidence interval, 0.75-1.48; P = .46, adjusted regression). The difference in secondary patency also was not statistically significant (85.7% for PTA vs 88%; P = .20). Adjusted Kaplan-Meier analysis revealed that the estimated primary patency was inferior for PTA in pairwise comparisons vs other treatments (P < .001 vs atherectomy; P = .002 vs directional atherectomy with drug-coated balloons; and P = .002 vs low-COF stenting).ConclusionsThe results from our study have shown that endovascular treatment of isolated popliteal lesions is safe and associated with acceptable patency and F-CDTLR in the mid-term.     

带髂内分支支架的腔内隔绝术治疗腹主动脉瘤伴双髂动脉瘤

目的探讨带髂内分支支架的腔内隔绝技术在腹主动脉瘤伴双髂动脉瘤治疗中的应用。方法回顾性分析2011年6月～2012年6月我院收治的10例腹主动脉瘤合并双髂动脉瘤患者的临床资料。患者均于术前行CT血管造影(CTA)检查,腹主动脉瘤均为肾下型;髂动脉瘤仅累及髂总动脉8例,累及髂内动脉开口处2例。手术先置入带髂内分支的髂动脉带膜支架,再置入腹主动脉瘤的分叉型带膜支架。结果患者均一次手术成功,无死亡。9例患者获得随访,随访时间3～6个月,患者腹部搏动性肿块均消失,均未出现臀部、骶尾部坏死,无明显性功能障碍,1例出现臀部的轻度间歇性跛行。8例术后3个月行腹主、双髂动脉彩超检查,未见明显内瘘,移植的髂内分支支架血流通畅。3例术后6个月行腹主、双髂动脉CTA检查,未见Ⅰ型、Ⅲ型内瘘,髂内分支支架内血流通畅。结论带髂内分支支架的腔内隔绝技术在腹主动脉瘤伴双髂动脉瘤的治疗中是安全、有效的;可以有效地保留一侧髂内动脉,减少或避免因髂内动脉封闭而带来的并发症。     

腔内技术重建髂内动脉治疗单纯髂动脉病变的近期疗效观察

背景与目的：髂内动脉病变可引起多种临床症状，积极治疗能明显改善患者的预后和生活质量。开放手术是髂动脉病变治疗的经典方法，但在技术方面要求更高，给患者带来的风险也更大，腔内技术重建髂内动脉已得到广泛应用，目前这方面的进展主要集中在合并腹主动脉瘤等治疗上，单纯针对髂动脉病变的研究较少。而且由于病变种类、解剖结构的复杂性，国内外尚无专门的指南或专家共识指导髂内动脉病变的诊治，腔内治疗技术缺少统一的规范。这就要求临床诊疗过程中术者需根据病变特点、入路解剖、自身经验等制定因人而异的策略。目前应用较为广泛、技术相对成熟的腔内治疗方法有腔内血管成形术、支架植入术等，合并髂外动脉者有“三明治”技术、分支支架技术等，各有利弊。本研究观察采用前述常见的腔内修复方法，针对髂内动脉病变患者，根据不同病情选择不同重建方案的近期治疗效果，以探讨应用个体化腔内技术重建髂内动脉的可行性。方法：回顾性分析2015年11月—2022年6月在国家心血管病中心行髂内动脉重建的13例单纯髂动脉病变患者资料。主要结局指标为有无术后新发臀肌跛行、勃起功能障碍等髂内动脉缺血症状，次要结局指标包括术后至少1个月复查主动脉CTA显示血流...     

腔内血管成形术治疗髂动脉长段慢性完全闭塞性病变

目的 评价腔内血管成形术治疗髂动脉长段慢性完全闭塞性病变(CTO)的可行性、有效性及安全性.方法 回顾性分析2006年1月至2010年12月经腔内血管成形术治疗的病变长度＞5 cm的髂动脉CTO患者139例(157条患肢)的临床资料.其中男性93例(105条患肢),女性46例(52条患肢);年龄50 ～96岁,平均年龄(77±10)岁.TASCⅡ分型:B型18例,C型89例,D型32例.采用左肱动脉和(或)股动脉穿刺经内膜下或血管内行髂动脉闭塞的球囊血管成形联合支架植入术治疗.结果 技术成功率96.2％ (151/157).踝肱指数由术前的0.42±0.19上升到术后的0.81±0.26.随访6～53个月,平均随访(30±7)个月,髂动脉支架畅通率94.1％ (111/118),7例发生支架内再狭窄或闭塞,无髂动脉破裂、支架移位、穿刺动脉假性动脉瘤及动静脉瘘的发生.结论 腔内血管成形术治疗髂动脉长段CTO安全、有效,术后支架通畅率高,联合肱动脉和股动脉双向穿刺技术能够显著提高技术成功率.     

Different association between renal dysfunction and clinical outcomes according to the presence of diabetes in patients undergoing endovascular treatment for peripheral artery disease

ObjectiveAlthough chronic kidney disease (CKD) and diabetes are important prognostic factors in patients with peripheral artery disease, there are limited data regarding the outcomes of endovascular treatment (EVT) according to the severity of CKD, especially in the presence of diabetes. This study sought to compare clinical outcomes of lower limb EVT between patients with and patients without CKD according to the presence of diabetes.MethodsPatients were enrolled from the Korean multicenter EVT registry and were divided according to the presence of diabetes, then further stratified by CKD (estimated glomerular filtration rate <60 mL/min/1.73 m²). The primary outcome was major adverse limb events (MALEs; a composite of reintervention for target limb, reintervention for target vessel, and unplanned major amputation) at 2 years.ResultsA total of 3045 patients were eligible for analysis: 1277 nondiabetic patients (944 without CKD, 333 with CKD) and 1768 diabetic patients (951 without CKD, 817 with CKD). CKD was associated with a significantly increased risk of MALEs after EVT in diabetic patients (14.4% vs 9.9%; adjusted hazard ratio, 1.60; 95% confidence interval, 1.28-2.01; P < .001) but not in nondiabetic patients (7.6% vs 9.7%; adjusted hazard ratio, 0.78; 95% confidence interval, 0.53-1.14; P = .203; interaction P = .018). In analysis stratified by the severity of CKD among diabetic patients, end-stage renal disease was significantly associated with an increased risk of MALE.ConclusionsCKD was associated with a significantly higher risk of MALEs after EVT in diabetic patients but not in nondiabetic patients. The increased risk of MALEs was mainly driven by patients with end-stage renal disease.     

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目的总结逆行锁骨下动脉支架植入治疗重度锁骨下动脉狭窄和闭塞的初步临床经验方法1999年9月至2003年7月采取经肱动脉逆行植入支架治疗锁骨下动脉重度狭窄和闭塞共19例术前诊断包括彩色多普勒超声检查和动脉造影确诊手术方法是经患侧上肢肘部小切口解剖肱动脉，逆行造影和支架植入。结果本组支架植入成功18例，支架植入满意，无移位。失败1例．因病变闭塞完全，导丝无法通过闭塞部位而转行手术治疗。治疗成功的18例中随访16例，随访时间2～48个月，平均24个月失访2例。随访率88.9％一有2例分别于术后11个月和14个月出现再狭窄，1例再次行球囊扩张成功，1例转行手术治疗结论逆行锁骨下动脉支架植入是治疗锁骨下动脉重度狭窄和闭塞安全有效的方法     

Fibromuscular disease of the external iliac artery

Fibromuscular disease is rarely observed in the external iliac artery. During the last 15 years, eight symptomatic cases were encountered in six women and two men whose ages ranged from 29 to 63 years (mean: 47 years). Clinical onset was always recent, either progressive with claudication (three cases) or sudden with abdominal and pelvic pain and acute ischemia due to dissection (five cases). Diagnosis was established by arteriograms showing either a typical appearance of fibromuscular hyperplasia or a segmental dissection or occlusion. Two patients had associated fibromuscular disease of the renal arteries. One of these patients had dysplastic aneurysm of the thyrocervical trunk. Histopathological findings were typical of medial fibromuscular hyperplasia in the seven cases examined. Even though transluminal dilatation is presently simple, adequate, and durable for the management of non-complicated forms, all of our cases were treated surgically either because they were observed before transluminal dilatation was readily available or because of associated dissection. Results of surgery were satisfactory in all cases except one with a mean follow-up of 12.6 years. One patient was reoperated upon 13 years later.Presented at the Annual Meeting of the Société de Chirurgie Vasculaire de Langue Française, June 21–22, 1991, Marseille, France.