血管成形术和内支架置入术对放射治疗后动脉损伤的治疗

目的评价经皮穿刺血管成形术和内支架置入术在放射治疗（简称放疗）后所致动脉疾病的治疗，及靶血管和内支架的长期支撑开放作用。方法１４例患者，因为放疗所致１８处动脉性病变，而给予血管球囊成形术治疗。并将１３个内支架置入于８例患者，分别治疗血管闭塞３例，动脉瘤１例，残存狭窄２例，多发狭窄１例，球囊成形术后再发狭窄１例。所有病例均用ＣＴ扫描和（或）多普勒超声检查，观察内支架及其靶血管内的血流情况。结果血管成形术成功治疗１４例，其中８例患者在动脉病变处置入内支架。随访８个月至５年，１１例动脉病变基本消失，血管造影示狭窄＜２０％，临床症状完全解除，３例狭窄＜３０％，临床症状改善。结论单一的血管成形术以及多技术综合运用，可有效治疗放疗所致的动脉性病变，应考虑其为动脉损伤性病变的首选治疗方法

Angioplasty and stent placement in the treatment of radiation induced arterial injury

Objective Evaluation of therapeutic efficacy and longterm patency of angioplasty and stenting for the treatment of radiation induced arterial disease. Methods PTA was attempted in 18 arterial lesions following irradiation in 14 patients. Thirteen stents were placed in 8 patients to treat occlusion ( n =3), aneurysm ( n =1), residual stenosis ( n =2), multiple stenoses ( n =1), and delayed restenosis after previous balloon angioplasty ( n =1). The stents were readily visualized and patency of the stent and the target artery determined with Doppler US and (or) CT in all patients. Results Interventional procedure was successful in 14 patients of which 8 underwent stent placement for their arterial lesions. Eleven of these patients demonstrated primary patency with relief of clinical symptoms with a mean follow up of 2 years (range, 8 months -60 months). Clinical improvement was noted for the other patients. Eleven patients underwent PTA once or twice. One patient had PTA four times and three stents were installed, two of which were in the area of the aortic bifurcation, and one in the celiac trunk. Another patient also had PTA four times and two stents were placed in the superior mesenteric artery. A stent was implanted in one patient because of PTA induced dissection and occlusion, and the arterial lesion was considered to be cured clinically after a follow up of 5 years. Conclusions Our results suggested that PTA with single or multiple techniques may be effective immediately in the treatment of arterial lesions caused by radiation and can be considered the first therapeutic option in these cases.