锁骨下动脉完全闭塞腔内治疗：附32例报告

目的：探讨锁骨下动脉完全闭塞腔内治疗的安全性及临床疗效。 方法：回顾2013年4月—2019年6月32例行腔内治疗的完全锁骨下动脉闭塞患者临床资料，分析患者的手术成功率、并发症及随访情况。 结果：分别采用经股动脉入路（17例）、肱动脉入路（1例）、股–肱联合入路（14例）对32例患者行腔内手术，最终成功植入支架26例（81.25%），包括球扩式支架15例，自膨式支架11例，术后患者症状明显缓解；6例患者闭塞处开通失败，行搭桥术或保守治疗。术中出现锁骨下动脉夹层2例，迷走反射1例，股动脉假性动脉瘤1例，未出现脑血管并发症。26例支架植入患者中，24例获随访（34.6±4.2）个月，术后1、3、5年支架累积通畅率分别为92.31%、80.77%、73.08%。 结论：腔内治疗锁骨下动脉闭塞安全有效，中远期通畅率较高；累及椎动脉的锁骨下动脉闭塞尽量选择自膨式支架。

Endovascular treatment of total subclavian artery occlusion: a report of 32 cases

Objective: To determine the safety and clinical efficacy of endovascular procedures in treatment of total subclavian artery occlusion. Methods: The clinical data of 32 patients with total subclavian artery occlusion undergoing endovascular treatment from April 2013 to June 2019 were reviewed. The surgical success rate, complications and follow-up results of the patients were analyzed. Results: Endovascular procedures were performed via a femoral artery approach (17 cases), brachial artery approach (1 case) and combined femoral/brachial approach (14 cases) in the 32 patients, and stents were successfully placed in 26 patients (81.25%), including balloon-expandable stent in 15 cases and self-expandable stent in 11 cases. The symptoms of patients were obviously relieved after stenting. Six patients underwent bypass operation or conservative treatment after failure of recanalization of the occlusion. During operation, dissection of the subclavian artery occurred in 2 cases, vagal reflex occurred in one case and femoral artery pseudoaneurysm occurred in one case, and no cerebrovascular complications occurred. In the 26 patients undergoing stent placement, 24 cases were followed up for (34.6±4.2) months, and the cumulative 1-, 3- and 5-year primary patency rates were 92.31%, 80.77% and 73.08%, respectively. Conclusion: Endovascular treatment for total occlusion of the subclavian artery is safe and effective, and it offers relatively high mid- and long-term patency rates. In patients with vertebral artery involvement, a self-expandable stent is strongly recommended to be used.