锁骨下动脉狭窄或闭塞腔内治疗25例疗效分析
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摘要
目的探讨锁骨下动脉病变的临床特点,并分析腔内治疗的效果及安全性。方法回顾性分析2010年10月至2012年12月在复旦大学附属中山医院25例锁骨下动脉病变患者的临床表现、腔内治疗和预后等相关临床资料,分析其临床特点、腔内治疗的疗效和安全性。结果 (1) 25例患者中左侧锁骨下动脉狭窄13例(腔内治疗植入支架13枚),闭塞10例(6例成功植入支架6枚,4例腔内治疗失败),右侧锁骨下动脉闭塞1例(成功植入支架1枚),双侧锁骨下动脉均有病变1例(其左锁骨下动脉闭塞段腔内治疗失败,右锁骨下动脉狭窄成功植入支架1枚)。失败病例均采用传统腋-腋人工血管搭桥手术治疗。(2)锁骨下动脉闭塞的腔内治疗成功率58. 33%(7/12),狭窄的腔内治疗成功率100%(14/14);腔内治疗成功患者患/健侧收缩压差从术前的(30. 67±4. 75) mm Hg降至术后的(12. 93±3. 35) mm Hg(t=15. 26,P <0. 01)。(3)于术后第3、6、12个月及第2、3、4、5年进行随访,行B超或CT血管成像检查,共随访36～60个月。术后第3、6、12个月随访一期通畅率分别为100%、100%和95. 23%;术后第2、3、4、5年的一期通畅率分别为90. 47%、85. 71%、80. 95%和71. 43%。(4)所有患者均未出现术中及术后并发症。结论腔内支架手术具有良好的近期及远期疗效,具有微创、术中术后并发症少、远期通畅率高等优点,已成为锁骨下动脉病变等治疗的首选方法,对于腔内治疗失败的病例,可采取传统手术治疗。
Objective To investigate the clinical features of subclavian artery lesions and analyze the efficacy and safety of endovascular treatment. Methods The related data of clinical manifestations,endovascular treatment and prognosis of 25 patients with subclavian artery disease in Zhongshan Hospital Affiliated to Fudan University from October 2010 to December2012 were retrospectively studied to analyze the clinical characteristics,efficacy and safety of endovascular treatment.Results( 1) In 25 patients,there were 13 cases of left subclavian artery stenosis( 13 stents were implanted by endovascular treatment),10 cases of occlusion( 6 stents were successfully implanted in 6 cases,and 4 cases of endovascular treatment failed),1 case of right subclavian artery occlusion( successful stent implantation),1 case of bilateral subclavian artery lesions( endovascular treatment of left subclavian artery occlusion failed,and right subclavian artery stenosis was successfully implanted with a stent). All failed cases were treated with conventional axillo-axillary bypass graft surgery.( 2) The success rate of endovascular treatment was 58. 33%( 7/12) in subclavian artery occlusion and 100%( 14/14) in subclavian artery stenosis. The systolic blood pressure difference between the affected side and the healthy side decreased from( 30. 67 ± 4. 75) mm Hg before operation to( 12. 93 ± 3. 35) mm Hg after operation( t = 15. 26,P < 0. 01).( 3) The patients were followed up for 36-60 months with B-Ultrasonography or CT angiography( CTA)examinations. The first-phase patency rates were 100%,100% and 95. 23% at postoperative 3-,6-and 12-month,and90. 47%,85. 71%,80. 95% and 71. 43% in postoperative 2-,3-,4-,and 5-year,respectively.( 4) No intraoperative and postoperative complications occurred in all patients. Conclusions Endovascular stent graft surgery has good short-term and long-term curative effects,with the advantages of minimal invasion,less intraoperative and postoperative complications,and high long-term patency rate. It has become the preferred method for the treatment of subclavian artery lesions. If endovascular treatment failed,conventional axillo-axillary bypass graft surgery can be performed.
Objective To investigate the clinical features of subclavian artery lesions and analyze the efficacy and safety of endovascular treatment. Methods The related data of clinical manifestations,endovascular treatment and prognosis of 25 patients with subclavian artery disease in Zhongshan Hospital Affiliated to Fudan University from October 2010 to December2012 were retrospectively studied to analyze the clinical characteristics,efficacy and safety of endovascular treatment.Results( 1) In 25 patients,there were 13 cases of left subclavian artery stenosis( 13 stents were implanted by endovascular treatment),10 cases of occlusion( 6 stents were successfully implanted in 6 cases,and 4 cases of endovascular treatment failed),1 case of right subclavian artery occlusion( successful stent implantation),1 case of bilateral subclavian artery lesions( endovascular treatment of left subclavian artery occlusion failed,and right subclavian artery stenosis was successfully implanted with a stent). All failed cases were treated with conventional axillo-axillary bypass graft surgery.( 2) The success rate of endovascular treatment was 58. 33%( 7/12) in subclavian artery occlusion and 100%( 14/14) in subclavian artery stenosis. The systolic blood pressure difference between the affected side and the healthy side decreased from( 30. 67 ± 4. 75) mm Hg before operation to( 12. 93 ± 3. 35) mm Hg after operation( t = 15. 26,P < 0. 01).( 3) The patients were followed up for 36-60 months with B-Ultrasonography or CT angiography( CTA)examinations. The first-phase patency rates were 100%,100% and 95. 23% at postoperative 3-,6-and 12-month,and90. 47%,85. 71%,80. 95% and 71. 43% in postoperative 2-,3-,4-,and 5-year,respectively.( 4) No intraoperative and postoperative complications occurred in all patients. Conclusions Endovascular stent graft surgery has good short-term and long-term curative effects,with the advantages of minimal invasion,less intraoperative and postoperative complications,and high long-term patency rate. It has become the preferred method for the treatment of subclavian artery lesions. If endovascular treatment failed,conventional axillo-axillary bypass graft surgery can be performed.
引文
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[10]黄友发,孙平,杨言府.血管内支架植入术治疗椎基底动脉重度狭窄患者23例临床分析[J].内科,2014,9(2):196-198.
[11] Sahsamanis G,Vourliotakis G,Pirgakis K,et al. Primary stenting of right-sided subclavian artery stenosis presenting as subclavian steal syndrome:report of 3 cases and literature review[J]. Ann Vasc Surg,2018,48:254.
[12]谢静,杨东霞.锁骨下动脉窃血综合征椎动脉血流频谱改变的研究[J].卫生职业教育,2017,35(3):153-155.
[13] Afari ME,Wylie JV Jr,Carrozza JP Jr. Refractory hypotension as an initial presentation of bilateral subclavian artery stenosis[J]. Case Rep Cardiol,2016,2016:8542312.
[14] Salman R,Hornsby J,Wright LJ,et al. Treatment of subclavian artery stenosis:a case series[J]. Int J Surg Case Rep,2016,19:69-74.
[15] Bachman DM,Kim RM. Transluminal dilatation for subclavian steal syndrome[J]. AJR Am J Roentgenol,1980,135(5):995-996.
[16]牛国晨,杨敏,宋莉,等.锁骨下动脉狭窄的腔内治疗[J].中国医师杂志,2016,18(11):1622-1625.
[17]李春民,姜双鹏,张望德.症状性锁骨下动脉狭窄或闭塞的腔内治疗效果分析[J].中华老年多器官疾病杂志,2016,15(3):178
[18]董鑫昌,狄长安,何亮.锁骨下动脉狭窄和闭塞病变的腔内治疗[J].中国实用医药,2017,12(5):17-19.
[2] Cwinn M,Nagpal S,Jetty P. Subclavian steal syndrome without subclavian stenosis[J]. J Vasc Surg Cases Innov Tech,2017,3(3):129-131.
[3] Zhang JL,Tong W,Lv JF,et al. Endovascular treatment and morphology typing of chronic ostial occlusion of the subclavian artery[J]. Exp Ther Med,2017,13(5):2022-2028.
[4]陈学明,李晨宇,冯海,等.椎动脉开口狭窄和闭塞的外科治疗经验[J].中国医师杂志,2014,16(7):865-867.
[5]徐温理.颈横—颈总动脉吻合术行脑血管重建[J].国际神经病学神经外科学杂志,1982,15(2):72-75.
[6]陈忠,吴庆华,唐小斌,等.腋-腋动脉人工血管转流术在血管外科疾病53例中的应用[J].中华普通外科杂志,2002,17(1):16-17.
[7]仲崇晓,孔萍.锁骨下动脉人工血管转流术患者的围手术期护理[J].中国实用护理杂志,2008,24(33):18-19.
[8] Wrotniak L,Kabak-Ziembicka A,Rosawiecka A,et al. Resolution of ischemic symptoms after percutaneous angioplasty for a symptomatic subclavian artery stenosis[J]. J Vasc Surg,2016,64(3):684-691.
[9]王燕,段峰,李志伟,等.预防血管内支架植入术后再狭窄的研究进展[J].介入放射学杂志,2011,20(8):665-668.
[10]黄友发,孙平,杨言府.血管内支架植入术治疗椎基底动脉重度狭窄患者23例临床分析[J].内科,2014,9(2):196-198.
[11] Sahsamanis G,Vourliotakis G,Pirgakis K,et al. Primary stenting of right-sided subclavian artery stenosis presenting as subclavian steal syndrome:report of 3 cases and literature review[J]. Ann Vasc Surg,2018,48:254.
[12]谢静,杨东霞.锁骨下动脉窃血综合征椎动脉血流频谱改变的研究[J].卫生职业教育,2017,35(3):153-155.
[13] Afari ME,Wylie JV Jr,Carrozza JP Jr. Refractory hypotension as an initial presentation of bilateral subclavian artery stenosis[J]. Case Rep Cardiol,2016,2016:8542312.
[14] Salman R,Hornsby J,Wright LJ,et al. Treatment of subclavian artery stenosis:a case series[J]. Int J Surg Case Rep,2016,19:69-74.
[15] Bachman DM,Kim RM. Transluminal dilatation for subclavian steal syndrome[J]. AJR Am J Roentgenol,1980,135(5):995-996.
[16]牛国晨,杨敏,宋莉,等.锁骨下动脉狭窄的腔内治疗[J].中国医师杂志,2016,18(11):1622-1625.
[17]李春民,姜双鹏,张望德.症状性锁骨下动脉狭窄或闭塞的腔内治疗效果分析[J].中华老年多器官疾病杂志,2016,15(3):178
[18]董鑫昌,狄长安,何亮.锁骨下动脉狭窄和闭塞病变的腔内治疗[J].中国实用医药,2017,12(5):17-19.