27例多发性大动脉炎血管介入治疗

目的探讨血管介入治疗多发性大动脉炎(Takayasu arteritis,TA)所致血管狭窄或闭塞性病变的临床疗效。方法 2003年6月～2011年6月对27例TA经股动脉穿刺选择性血管造影,确定病变部位,明确诊断,并对因大动脉炎引起的锁骨下动脉、颈动脉、肾动脉、腹主动脉病变进行了选择性球囊扩张或支架植入手术。结果 27例施行血管腔内扩张成形术或支架植入术,其中颈总动脉扩张10例,支架2例;锁骨下动脉扩张6例;腹主动脉扩张4例;肾动脉扩张10例,支架4例;无名动脉扩张1例,支架1例;共置入支架7枚。2例颈动脉扩张时因并发症而终止治疗,其余病例病变血管均获得满意的治疗。27例随访5个月～7年,平均4年,其中<12个月6例,1～3年12例,3～5年6例,>5年3例:11例头晕、视觉异常等脑缺血症状改善;12例肾动脉狭窄所致高血压经球囊扩张及支架植入后血压控制正常;2例肾动脉狭窄在球囊扩张后14、18个月再次发生血压增高,造影显示扩张后肾动脉再次狭窄,再次行肾动脉球囊扩张成形术,扩张后高血压恢复正常。结论介入性血管内成形术治疗TA所致血管狭窄或闭塞性病变疗效满意。

Endovascular Interventional Therapy for Takayasu Arteritis:Report of 27 Cases

Objective To investigate the efficacy of endovascular interventional therapy for vascular stenosis or occlusion caused by Takayasu arteritis.Methods Totally 27 cases of endovascular interventional therapy were carried out in our hospital from June 2003 to June 2011.All the patients received femoral artery puncture for selective angiography.Multiple Takayasu arteritis was diagnosed and located at the subclavian,carotid,and renal arteries,or abdominal aorta.Selective balloon dilation or stent grafting were carried out accordingly.Results Endovascular angioplasty or stent grafting were completed in all the patients.The procedures performed included 10 cases of carotid artery dilation,2 cases of carotid artery stenting,6 cases of subclavian artery dilation,4 cases of abdominal aorta dilation,10 cases of renal artery dilation,4 cases of renal artery stenting,1 case of innominate artery dilation,and one case of innominate artery stenting.Totally 7 stents were placed.In two cases,carotid artery dilation was stopped because of complications,all the other diseased vessels were well dilated or patent after the procedure.The 27 patients were followed up for 5 months to 7 years,with a mean of 4 years(<12 months in 6 cases,1-3 years in 12 cases,3-5 years in 6 cases,and >5 years in 3 cases).During the follow-up,the symptoms of cerenbral ischemia,such as dizziness and paropsis,were improved in 11 patients;in 12 patients,who had hypertension that were caused by renal artery stenosis,the blood pressure was controlled in a normal range after balloon dilation or stent grafting;hypertension was detected again in 2 patients with renal stenosis in 14 and 18 months respectively after balloon dilation,angiography showed re-stenosis of the renal artery,and thus balloon dilation was carried out again,after which both the patients were cured.Conclusion Endovascular interventional therapy is effective for vascular stenosis or obstruction caused by Takayasu arteritis.