右锁骨下动脉狭窄和闭塞的腔内治疗

目的:探讨腔内治疗右锁骨下动脉狭窄和闭塞的手术指征、特点和疗效。方法:选择2009年3月—2013年3月复旦大学附属中山医院诊治的右锁骨下动脉狭窄和闭塞患者21例,局麻下腔内治疗后1个月、3个月时门诊随访,此后每隔半年门诊随访,行踝肱指数(ankle-brachial index,ABI)、彩超检查或CT血管成像(CT angiography,CTA)检查。结果:21例患者中右锁骨下动脉闭塞性病变7例,狭窄性病变14例。2例右锁骨下动脉闭塞患者因导丝无法通过闭塞段病变而仅行造影,其余19例均成功行腔内治疗,总成功率为90.5%。19例行腔内治疗的患者术后平均随访19.3个月,通畅率为89.5%(17/19),中度再狭窄率为10.5%(2/19),无支架断裂和打折,无病死病例。结论:右锁骨下动脉狭窄和闭塞有其特殊的解剖学特点,腔内治疗是一种有效的治疗方法。

Endovascular Treatment for Right Subclavian Artery Stenosis and Occlusion

Objective：To analyze and discuss the indication,features and efficacy of endovascular treatment for right subclavian artery stenosis and occlusion.Methods：From Mar 2009 to Mar 2013,a total of 21 patients with right subclavian artery stenosis and occlusion treated in Zhongshan Hospital,Fudan University were enrolled.Patients were given endovascular treatment under local anesthesia.Patients were followed up at 1 month and3 months after operation and then every6 months,and ankle-brachial index（ABI）and doppler ultrasonography or CT angiography（CTA）scan were done.Results：Of the 21 cases,there were 7 patients with chronic total occlusion（CTO）and 14 patients with severe stenosis.And 2 cases with CTO had only received angiography,because the guidewire could not pass through.The other 19 patients successfully underwent endovascular treatment.The success rate was 90.5%in all.The mean followed-up period was 19.3 months with a patency rate of 89.5%（17/19）and a moderate restenosis rate of 10.5%（2/19）.There was no death,no stent broken or fracture.Conclusions：Right subclavian artery stenosis and occlusion has some special anatomic features,the short-to medium-term outcomes of endovascular treatment are satisfied.