主-髂-股动脉闭塞性病变介入治疗的技术探讨及疗效观察

目的探讨主-髂-股动脉闭塞性病变介入治疗的技术要点。方法本组34例主-髂-股动脉闭塞的患者中，腹主动脉下段、双侧髂动脉完全闭塞8例，同时肾动脉受累3例；单侧髂动脉闭塞23例，其中病变累及股总动脉4例；单纯单侧股浅动脉长段闭塞3例。分别行闭塞段开通、经导管局部溶栓、血管腔内成形术(PTA)和内支架置人等多种介入方法综合治疗。结果除3例髂动脉闭塞未能开通外，8条腹主动脉，36条髂动脉，4条股总动脉和3条股浅动脉均得以开通，开通率为94％。共置入裸支架46枚，覆膜支架3枚。其中包括腹主动脉支架6枚，髂动脉支架34枚，股总动脉支架2枚、股浅动脉支架4枚和肾动脉支架3枚。在治疗成功的31例中，9例临床症状和体征得到缓解，21例明显改善，1例因长期慢性肾功能衰竭于术后第2天死亡；其中4例合并有并发症。术后平均随访21．5个月(2～53个月)，除2例分别在术后2个月和14个月发生支架内再闭塞行二次介入治疗外，其余患者症状均无加重或复发。结论综合应用多种介入方法治疗主-髂-股动脉闭塞性病变是一项安全有效的治疗手段，可获得满意的临床效果。

The technical exploration and efficacy observation of interventional treatment for occlusion of aorto-iliac-femoral artery

Objective To explore the technical main points of interventional treatment for occlusion of aorto-iliac-femoral artery. Methods Thirty-four patients with occlusion of aorto-iliac-femoral artery were observed after interventional treatment. There were 8 cases with the complete occlusion of inferior segment of abdominal aorta and bilateral iliac artery, including 3 cases with stenosis of renal artery. There were 23 cases with occlusion of single iliac artery, including 4 cases with occlusion of common femoral artery. There were 3 cases with occlusion of single superficial femoral artery only. They were all treated by combined interventional techniques, such as recanalization, local thrombolysis via catheter, percutaneous transluminal angioplasty (PTA), and implantation of stent. Results 8 abdominal aortas, 36 iliac arteries, 4 common femoral arteries and 3 superficial femoral arteries were all recanalized except 3 iliac arteries. The rate of patency was 94%. 46 naked stents and 3 coated stents were placed totally, including 6 abdominal aortas stents, 34 iliac artery stents, 2 common femoral artery stents, 4 superficial femoral artery stents, and 3 renal artery stents. In 31 successfully treated cases, there were 9 cases with relief of symptoms and signs and 21 cases with obvious improvement but 1 case died of long-term chronic renal failure at the 2 nd day after treatment. And complications were observed in 4 cases. All the patients were followed-up for 2-53 months (mean 21.5 months). Among them, 2 cases were treated again by interventional methods respectively at the 2 nd month and the 14 th month for reocclusion of inner stents, and symptoms in other cases showed no deterioration. Conclusion Comprehensive application of multiple-interventional techniques can be a safe and effective method in treating the occlusion of aorto-iliac-femoral artery and obtaining satisfactory clinical efficacy.